Lior Heller1, Scott L Levin, Charles E Butler. 1. Department of Plastic Surgery, Unit 443, The University of Texas M.D. Anderson Cancer Center, PO Box 301402, Houston, TX 77230, USA.
Abstract
BACKGROUND: Restoration of the abdominal wall's integrity after postoperative wound dehiscence is frequently performed in a delayed fashion, necessitating a temporary dressing of the dehisced wound. METHODS: The Vacuum Assisted Closure (VAC) system (Kinetic Concepts, Inc., San Antonio, TX) was used in 21 patients with postoperative abdominal wound dehiscences that could not be closed immediately and who were at high risk for healing complications. The VAC device was used in conjunction with sharp debridement and it was maintained on a continuous mode with a negative pressure of -75 to -125 mm Hg. The dressing was changed every 2 days. VAC therapy was continued until the integrity of the abdominal wall was reestablished by surgical procedures or secondary healing. RESULTS: Thirteen patients had fascial dehiscence, and 9 of them had frank bowel exposure. Definitive fascial closure was performed in 9 of 13 patients with fascial dehiscence. Stable cutaneous coverage was subsequently achieved in all patients by local abdominal skin flap advancement (6), skin grafting (9), or secondary intention healing (6). Seven patients had part of their VAC therapy as outpatients. The complications included a low-output small bowel enterocutaneous fistula in 2 patients and partial skin graft loss in 1 patient. The fistulae resolved after operative treatment (1) or conservative treatment (1). CONCLUSION: Integration of the VAC system in the management of post-laparotomy wound dehiscence in patients with compromised wound healing appears to be successful and should be considered in such patients to provide a stable, healed wound.
BACKGROUND: Restoration of the abdominal wall's integrity after postoperative wound dehiscence is frequently performed in a delayed fashion, necessitating a temporary dressing of the dehisced wound. METHODS: The Vacuum Assisted Closure (VAC) system (Kinetic Concepts, Inc., San Antonio, TX) was used in 21 patients with postoperative abdominal wound dehiscences that could not be closed immediately and who were at high risk for healing complications. The VAC device was used in conjunction with sharp debridement and it was maintained on a continuous mode with a negative pressure of -75 to -125 mm Hg. The dressing was changed every 2 days. VAC therapy was continued until the integrity of the abdominal wall was reestablished by surgical procedures or secondary healing. RESULTS: Thirteen patients had fascial dehiscence, and 9 of them had frank bowel exposure. Definitive fascial closure was performed in 9 of 13 patients with fascial dehiscence. Stable cutaneous coverage was subsequently achieved in all patients by local abdominal skin flap advancement (6), skin grafting (9), or secondary intention healing (6). Seven patients had part of their VAC therapy as outpatients. The complications included a low-output small bowel enterocutaneous fistula in 2 patients and partial skin graft loss in 1 patient. The fistulae resolved after operative treatment (1) or conservative treatment (1). CONCLUSION: Integration of the VAC system in the management of post-laparotomy wound dehiscence in patients with compromised wound healing appears to be successful and should be considered in such patients to provide a stable, healed wound.
Authors: Julia Mees; Wolf Arif Mardin; Norbert Senninger; Matthias Bruewer; Daniel Palmes; Soeren Torge Mees Journal: Langenbecks Arch Surg Date: 2012-08-10 Impact factor: 3.445
Authors: M López-Cano; J M García-Alamino; S A Antoniou; D Bennet; U A Dietz; F Ferreira; R H Fortelny; P Hernandez-Granados; M Miserez; A Montgomery; S Morales-Conde; F Muysoms; J A Pereira; R Schwab; N Slater; A Vanlander; G H Van Ramshorst; F Berrevoet Journal: Hernia Date: 2018-09-03 Impact factor: 4.739