Early Results after Treatment of Open Abdomen after Aortic Surgery with Mesh Traction and Vacuum-Assisted Wound Closure

Abstract 

Objectives

This study aimed to describe the use of vacuum-assisted wound closure (VAWC) and mesh traction to repair an open abdomen after aortic surgery.

Design

Prospective clinical study.

Material and methods

From October 2006 to April 2009, nine consecutive patients were treated; seven of the patients received laparostomy following abdominal compartment syndrome (ACS), while two wounds were left open initially. The indication for laparostomy was intra-abdominal pressure (IAP) > 20 mmHg or abdominal perfusion pressure (APP) < 60 mmHg and development of organ failure. V.A.C. therapy (KCI, San Antonio, TX, USA) was initiated with the laparostomy, and supplemented with a fascial mesh after 2 days. The wound was then closed stepwise with mesh traction and VAWC.

Results

All wounds could be closed following a median interval of 10.5 (range: 6–19) days after laparostomy. A median of four (range: 2–7) dressing changes were performed. One patient died on the seventh postoperative day. Two other patients died 38 and 50 days after final closure, respectively. Left colonic necrosis was seen in two patients while incisional hernia was observed in two patients. Mean follow-up duration was 17 (range: 2–36) months.

Conclusion

VAWC with mesh traction was successful in terms of early delayed primary closure and is a useful tool in the treatment of open abdomen after aortic surgery.

Keywords: Abdominal compartment syndrome (ACS), Open abdomen, Ruptured abdominal aortic aneurysm (rAAA), Vacuum-assisted wound closure (VAWC)