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. 2019:61:174-179.
doi: 10.1016/j.ijscr.2019.07.047. Epub 2019 Jul 22.

Myths and realities in the management of the open abdomen with negative pressure systems. A case report and literature review

J Aguilar-Frasco  1 , P Moctezuma-Velázquez  2 , J H Rodríguez-Quintero  2 , F U Pastor-Sifuentes  2 , E Sanchez Garcia-Ramos  2 , U Clemente-Gutierrez  2 , J Morales-Maza  2 , O Santes  2 , J D Hernández-Acevedo  2 , E Contreras-Jimenez  2 , S Mier Y Terán  2
Affiliations

Myths and realities in the management of the open abdomen with negative pressure systems. A case report and literature review

J Aguilar-Frasco et al. Int J Surg Case Rep. 2019.

Abstract

Introduction: The open abdomen is a useful resource for treating patients with abdominal hypertension and abdominal compartment syndrome. Currently, early closure assisted with negative pressure devices is considered standard of treatment, and its use has demonstrated favorable outcomes and a decreased rate of complications.

Presentation of a case: We present a case of a 32-year-old male patient with diagnosis of non-seminomatous germinal testicular tumor (Stage IIIB (T3-N3-M1), which was summited to surgery, as a complication he presented massive bleeding, that culminated in acute compartment syndrome. With the aforementioned findings the patient re entered the operating room and was managed with open abdomen combined with a medial retraction technique of the abdominal fascia. Currently, the patient has not presented recurrence or late complications after a year.

Discussion: The use of negative pressure techniques for open abdomen management began to be generalized in 1995. Subsequently, this technique evolved to V.A.C therapy (Vacuum-assisted closure therapy). Currently, these negative pressure techniques have become the most used method for the temporary closure and management of open abdomen. Controversies continue to limit its widespread use and effectiveness.

Conclusion: Adequate application of negative pressure therapy in combination with techniques of medial retraction of the abdominal fascia, have proved to be useful in management for patients with open abdomen.

Keywords: Abdominal sepsis; Negative pressure therapy; Open abdomen; V.A.C therapy.

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Figures

Fig. 1
Fig. 1
Open abdomen management diagram.
Fig. 2
Fig. 2
ABThera system placement. a) Protective visceral layer, b) Placement of the first retrofascial polyurethane dressing.
Fig. 3
Fig. 3
a–b) traction and closure of the mesh, c) placement of the second dressing and track to suction.
Fig. 4
Fig. 4
Abdominal wall closure. a–b) withdrawal of ABThera system and fascial traction mesh, c–d) anterior separation of components with a wall closure.
Fig. 5
Fig. 5
Barker technique. a) Suction drainage b) Adherent plastic cover c) Polyurethane sponge d) Polyethylene protective layer.
See this image and copyright information in PMC

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