Vacuum-Assisted Wound Closure and Permanent Onlay Mesh-Mediated Fascial Traction: A Novel Technique for the Prevention of Incisional Hernia after Open Abdomen Therapy Including Results From a Retrospective Case Series.

Abstract

Incisional hernia development is a frequent long-term sequel after open abdomen treatment. This report describes a novel technique, the vacuum-assisted wound closure and permanent onlay mesh-mediated fascial traction for temporary and final closure of the open abdomen, with the intention to decrease incisional hernia rates. Primary aim was to evaluate incisional hernia development and secondary aims to describe short-term complications and patient-reported outcome. The basics of the technique is an onlay mesh, applied early during open abdomen treatment by suturing to the fascia in two rows with a 3- to 4-cm overlap from the midline incision, used for traction and kept for reinforced permanent closure. A retrospective case series, including chart review, evaluation of computed tomography/ultrasound images, and an out-patient clinical examination were performed. The patients were asked to answer a modified version of the ventral hernia pain questionnaire. A total of 11 patients were treated with vacuum-assisted wound closure and permanent onlay mesh-mediated fascial traction with median follow-up of 467 days. Fascial closure rate was 100% and 30 day mortality 0%. Two of nine patients, eligible for incisional hernia follow-up, developed a hernia. Neither of the hernias were symptomatic nor clinically detectable. Six of 10 patients eligible for short-term follow-up had a prolonged wound-healing time exceeding 3 weeks. One of seven patients eligible for patient-reported outcome have had pain during the last week. The vacuum-assisted wound closure and permanent onlay mesh-mediated fascial traction is a promising new technique for open abdomen treatment and reinforced fascial closure. The results of the first 11 patients treated with this technique show a low incisional hernia rate with manageable short-term wound complications and few patient-reported disadvantages.