Abstract
Open abdomen (OA) has been an effective treatment for abdominal catastrophes in traumatic and general surgery. However, management of patients with OA remains a formidable task for surgeons. The central goal of OA is closure of fascial defect as early as is clinically feasible without precipitating abdominal compartment syndrome. Historically, techniques such as packing, mesh, and vacuum-assisted closure have been developed to assist temporary abdominal closure, and techniques such as components separation, mesh-mediated traction, bridging fascial defect with permanent synthetic mesh, or biologic mesh have also been attempted to achieve early primary fascial closure, either alone or in combined use. The objective of this review is to present the challenges of these techniques for OA with a goal of early primary fascial closure, when the patient's physiological condition allows.
Highlights
Direct pressure has long been used until World War II for hemostasis, especially in patients with coagulopathy
Along with improved understanding of the pathophysiology of inflammation, injury response, and Intra-abdominal hypertension (IAH)/abdominal compartment syndrome (ACS), the use of open abdomen has increased, which prompted the development of the various techniques of temporary abdominal closure (TAC)
This study found that by comparing with the vacuum pack dressings group, the ABThera System was associated with a significantly higher 30-day primary fascial closure rate and a lower 30-day all-cause mortality rate
Summary
Direct pressure has long been used until World War II for hemostasis, especially in patients with coagulopathy It was abandoned because of recurrent bleeding at pack removal and late infection. In 1993, pioneered by Rotondo et al [5], surgeons began to recognize that patients with major injuries were more likely to die from intraoperative metabolic failure (the vicious triad of coagulopathy, acidosis, and hypothermia) than from failure to complete operative repairs. Codified as “damage-control” laparotomy, patients are left with open abdomen (OA) with a planned return to the operating room for definitive surgery. Along with improved understanding of the pathophysiology of inflammation, injury response, and IAH/ACS, the use of open abdomen has increased, which prompted the development of the various techniques of temporary abdominal closure (TAC)
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