Negative pressure wound therapy management of the "open abdomen" following trauma: a prospective study and systematic review

Abstract

Introduction: The use of Negative Pressure Wound Therapy (NPWT) for temporary abdominal closure of open abdomen (OA) wounds is widely accepted. Published outcomes vary according to the specific nature and the aetiology that resulted in an OA. The aim of this study was to evaluate the effectiveness of a new NPWT system specifically used OA resulting from abdominal trauma.

Methods: A prospective study on trauma patients requiring temporary abdominal closure (TAC) with grade 1or 2 OA was carried out. All patients were treated with NPWT (RENASYS AB Smith & Nephew) to achieve TAC. The primary outcome measure was time taken to achieve fascial closure and secondary outcomes were complications and mortality.

Results: A total of 20 patients were included. Thirteen patients (65%) achieved fascial closure following a median treatment period of 3 days. Four patients (20%) died of causes unrelated to NPWT. Complications included fistula formation in one patient (5%) with spontaneous resolution during NPWT), bowel necrosis in a single patient (5%) and three cases of infection (15%). No fistulae were present at the end of NPWT.

Conclusion: This new NPWT kit is safe and effective and results in a high rate of fascial closure and low complication rates in the severely injured trauma patient.

Figure 1

A 27 year old male was admitted with blunt abdominal trauma. A damage control laparotomy was performed (A), 90 cm of necrotic bowel removed (B) and NPWT (Renasys F-AB, Smith & Nephew) applied at -80 mmHg (C). Second look lapartomies were performed at 24 and 48 hours (D) and the fascia closed at Day 3 post injury (E).