Modified Application of Dynamic Wound Closure System in the Management of Septic Open Abdomen
Fahri Yetişir, A Ebru Salman, Fatih Özdemir, Doğukan Durak, Onur Özlü and Mehmet Kılıç
World Journal of Trauma and Critical Care Medicine 2013, 1:1
We aimed to present the management of 6 cases of Open Abdomen with severe peritonitis and ostomies by the application of U shaped dynamic wound closure system (ABRA) in conjunction with VAC dressing in this case series.
Material and Method
Six open abdomen cases with severe peritonitis treated with modified application of ABRA in conjunction with VAC dressing between 2011 January and 2012 September were presented in this study. After hemodynamic stabilization in ICU, VAC dressing was applied and changed every 2-5 days until the fascia of patients was closed. The first modified application of ABRA (U shaped) was decided based on the clinical judgment. The arms of U shaped ABRA were placed on non-ostomy side of septic OA. When all the wound edges came across completely, it was sutured. One-two weeks after facial closure, the anchors of ABRA were removed.
Mean APACHE II score was 23.67± 4.76. Mean Mannheim peritonitis index (MPI) score was 36.0±5.1, Björck OA score of 1 patient is 2b, 2 patients 3 and 3 patients, 4 at the time of first application of VAC dressing. Mean width and length of the abdominal defect was 20.5 ± 14.6 cm and 26.2 ± 8.7 cm respectively. There was no mortality. Successful delayed abdominal closure rate was 100%. Abdominal wall hernia developed in only 1 patient.
Modified application of ABRA decreases the cost of the treatment and provides more space for placement of ostomy bags in patients with ostomies in septic OA.
dynamic closure, negative pressure, open abdomen, peritonitis.