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Review
. 2012 Aug;9 Suppl 1(Suppl 1):17-24.
doi: 10.1111/j.1742-481X.2012.01018.x.

Total management of the open abdomen

Demetrios Demetriades  1
Affiliations
Review

Total management of the open abdomen

Demetrios Demetriades. Int Wound J. 2012 Aug.

Abstract

The management of complex abdominal problems with the 'open abdomen' (OA) technique has become a routine procedure in surgery. The number of cases treated with an OA has increased dramatically because of the popularisation of damage control for life-threatening conditions, recognition and treatment of intra-abdominal hypertension and abdominal compartment syndrome and new evidence regarding the management of severe intra-abdominal sepsis. Although OA has saved numerous lives and has addressed many problems related to the primary pathology, this technique is also associated with serious complications. New knowledge about the pathophysiology of the OA and the development of new technologies for temporary abdominal wall closure (e.g. ABThera™ Open Abdomen Negative Pressure Therapy; KCI USA Inc., San Antonio, TX) has helped improve the management and outcomes of these patients. This review will merge expert physician opinion with scientific evidence regarding the total management of the OA.

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Conflict of interest statement

Dr DD has a consulting agreement with Kinetic Concepts, Inc. This article is part of an educational supplement funded by Kinetic Concepts Inc. to provide an overview of the V.A.C.® Therapy family of products for new users in developing markets.

Figures

Figure 1
Figure 1
(A) Skin approximation with towel clips. (B) Bogota Bag. (C) Absorbable mesh that often extrudes from the wound and results in an incisional hernia.
Figure 2
Figure 2
(A) Example of Barker's vacuum packing technique. (B) Example of the Vacuum‐Assisted Closure® Abdominal Dressing System.
Figure 3
Figure 3
(A) Open abdomen. (B) Polyurethane foam with six strut arms, embedded between two fenestrated non adherent sheets placed directly over the bowel and tucked under the peritoneum. (C) Perforated foam cut into size and shape is placed over the protective foam. (D) The foam is covered by a semi‐occlusive adhesive drape. (E) A small piece of the adhesive drape and underlying foam are excised and an interface pad with a tubing system is applied over this opening and connected to an NPT unit. (F) Definitive fascial and skin closure 9 days after the initial operation.
Figure 4
Figure 4
(A) Distribution of negative pressure with ABThera™ open abdomen negative pressure therapy. (B) Distribution of negative pressure with Barker's vacuum pack technique. (Reprinted with permission from KCI Licensing, Inc.)
See this image and copyright information in PMC

References

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MeSH terms