Delayed closure of open abdomen in septic patients is facilitated by combined negative pressure wound therapy and dynamic fascial suture
Introduction The aim of this prospective controlled trial was the definition of the optimal timepoint for delayed closure after negative pressure wound therapy (NPWT) in the treatment of the open abdomen (OA) in septic patients after abdominal surgery. The delayed closure of the abdominal wall after...
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description | Introduction
The aim of this prospective controlled trial was the definition of the optimal timepoint for delayed closure after negative pressure wound therapy (NPWT) in the treatment of the open abdomen (OA) in septic patients after abdominal surgery. The delayed closure of the abdominal wall after abdominal NPWT treatment is often problematic due to the lateralization of the fascial edge leading to unfavorably high tensile forces of the adapting sutures in the midline. We present the results of an innovative combination of NPWT with a new fascial-approximation technique using dynamic fascial sutures (DFS) and delayed closure of the abdominal wall.
Methods
Eighty-seven patients subjected to OA therapy following surgery for secondary peritonitis were treated with NPWT and DFS. In all patients, a running suture of elastic vessel loops was used to approximate fascial edges. This procedure was continued for the duration of NPWT until final closure of the abdomen with running suture in 55 patients (63.2 %) and interrupted suture technique in eight patients (9.2 %). An anterior component separation was performed in seven patients.
Results
Delayed closure was achieved in 68 patients (78.2 %) after 12.6 days [mean (SD) 25.1 (2–204)] days and 4.3 re-operations [mean (SD) 6.0 (1–43)]. Fifteen (17.2 %) superficial and two (2.3 %) deep wound infections occurred. In three (3.4 %) cases, entero-atmospheric fistulas had to be treated. We recorded no technique-specific complications. Four (5.9 %) incisional hernia were detected in a mean follow-up of 40.5 months (16–65). Mortality rate was 55.2 %.
Conclusion
Using a new technique combining NPWT and DFS in the treatment of the OA, the delayed closure of the fascial edges by running suture can be achieved and the number of re-operations can be kept low. The technique was safe and led to a low incidence of incisional hernias. Extensive abdominal wall reconstruction was seldom required. |
doi_str_mv | 10.1007/s00464-013-3251-6 |
format | Article |
fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1501837885</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1501837885</sourcerecordid><originalsourceid>FETCH-LOGICAL-c372t-5c1564992642cbd192577c90e52e6d6d40fb23b05b63492a987c8a3791a2fbf13</originalsourceid><addsrcrecordid>eNp1kc1qFjEUhoMo9mv1AtxIwI2b0fzPZCmtVqHgRtchyZypKTPJmGSUuQMv23x-VURwdQ7keZ8ceBF6RskrSkj_uhAilOgI5R1nknbqATpQwVnHGB0eogPRnHSs1-IMnZdyRxquqXyMzpigQg9SHtCPK5jtDiP2cypbBpwmnFaI2LoxLW2GiAusNXi82hog1oJDwZP1YQ7V1pZ0O_ZpcSG2PcJto74BXjOUX77vaYsjrl8g23XHtu3jHu3SfJMtPtgZl6028Al6NNm5wNP7eYE-v3v76fJ9d_Px-sPlm5vO857VTnoqldCaKcG8G6lmsu-9JiAZqFGNgkyOcUekU1xoZvXQ-8HyXlPLJjdRfoFenrxrTl83KNUsoXiYZxshbcVQSejA-2GQDX3xD3qXthzbdUeKaKKVZo2iJ8rnVEqGyaw5LDbvhhJzrMmcajKtJnOsyaiWeX5v3twC45_E714awE5AaU_xFvJfX__X-hPASp44</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1500909692</pqid></control><display><type>article</type><title>Delayed closure of open abdomen in septic patients is facilitated by combined negative pressure wound therapy and dynamic fascial suture</title><source>MEDLINE</source><source>SpringerNature Journals</source><creator>Fortelny, René H. ; Hofmann, Anna ; Gruber-Blum, Simone ; Petter-Puchner, Alexander H. ; Glaser, Karl S.</creator><creatorcontrib>Fortelny, René H. ; Hofmann, Anna ; Gruber-Blum, Simone ; Petter-Puchner, Alexander H. ; Glaser, Karl S.</creatorcontrib><description>Introduction
The aim of this prospective controlled trial was the definition of the optimal timepoint for delayed closure after negative pressure wound therapy (NPWT) in the treatment of the open abdomen (OA) in septic patients after abdominal surgery. The delayed closure of the abdominal wall after abdominal NPWT treatment is often problematic due to the lateralization of the fascial edge leading to unfavorably high tensile forces of the adapting sutures in the midline. We present the results of an innovative combination of NPWT with a new fascial-approximation technique using dynamic fascial sutures (DFS) and delayed closure of the abdominal wall.
Methods
Eighty-seven patients subjected to OA therapy following surgery for secondary peritonitis were treated with NPWT and DFS. In all patients, a running suture of elastic vessel loops was used to approximate fascial edges. This procedure was continued for the duration of NPWT until final closure of the abdomen with running suture in 55 patients (63.2 %) and interrupted suture technique in eight patients (9.2 %). An anterior component separation was performed in seven patients.
Results
Delayed closure was achieved in 68 patients (78.2 %) after 12.6 days [mean (SD) 25.1 (2–204)] days and 4.3 re-operations [mean (SD) 6.0 (1–43)]. Fifteen (17.2 %) superficial and two (2.3 %) deep wound infections occurred. In three (3.4 %) cases, entero-atmospheric fistulas had to be treated. We recorded no technique-specific complications. Four (5.9 %) incisional hernia were detected in a mean follow-up of 40.5 months (16–65). Mortality rate was 55.2 %.
Conclusion
Using a new technique combining NPWT and DFS in the treatment of the OA, the delayed closure of the fascial edges by running suture can be achieved and the number of re-operations can be kept low. The technique was safe and led to a low incidence of incisional hernias. Extensive abdominal wall reconstruction was seldom required.</description><identifier>ISSN: 0930-2794</identifier><identifier>EISSN: 1432-2218</identifier><identifier>DOI: 10.1007/s00464-013-3251-6</identifier><identifier>PMID: 24149855</identifier><language>eng</language><publisher>Boston: Springer US</publisher><subject>Abdomen ; Abdomen - surgery ; Abdominal Surgery ; Abdominal Wound Closure Techniques ; Adult ; Aged ; Aged, 80 and over ; Approximation ; Austria - epidemiology ; Fasciotomy ; Female ; Follow-Up Studies ; Gastroenterology ; Gynecology ; Hepatology ; Hernias ; Humans ; Infections ; Laparotomy - adverse effects ; Leukocytes ; Male ; Medical personnel ; Medicine ; Medicine & Public Health ; Middle Aged ; Mortality ; Negative-Pressure Wound Therapy - methods ; Peritonitis ; Peritonitis - surgery ; Proctology ; Prospective Studies ; Reoperation ; Sepsis - etiology ; Surgery ; Surgical Wound Infection - complications ; Surgical Wound Infection - mortality ; Surgical Wound Infection - therapy ; Survival Rate - trends ; Suture Techniques ; Sutures ; Time Factors ; Treatment Outcome ; Wound healing</subject><ispartof>Surgical endoscopy, 2014-03, Vol.28 (3), p.735-740</ispartof><rights>Springer Science+Business Media New York 2013</rights><rights>Springer Science+Business Media New York 2014</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c372t-5c1564992642cbd192577c90e52e6d6d40fb23b05b63492a987c8a3791a2fbf13</citedby><cites>FETCH-LOGICAL-c372t-5c1564992642cbd192577c90e52e6d6d40fb23b05b63492a987c8a3791a2fbf13</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00464-013-3251-6$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00464-013-3251-6$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24149855$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Fortelny, René H.</creatorcontrib><creatorcontrib>Hofmann, Anna</creatorcontrib><creatorcontrib>Gruber-Blum, Simone</creatorcontrib><creatorcontrib>Petter-Puchner, Alexander H.</creatorcontrib><creatorcontrib>Glaser, Karl S.</creatorcontrib><title>Delayed closure of open abdomen in septic patients is facilitated by combined negative pressure wound therapy and dynamic fascial suture</title><title>Surgical endoscopy</title><addtitle>Surg Endosc</addtitle><addtitle>Surg Endosc</addtitle><description>Introduction
The aim of this prospective controlled trial was the definition of the optimal timepoint for delayed closure after negative pressure wound therapy (NPWT) in the treatment of the open abdomen (OA) in septic patients after abdominal surgery. The delayed closure of the abdominal wall after abdominal NPWT treatment is often problematic due to the lateralization of the fascial edge leading to unfavorably high tensile forces of the adapting sutures in the midline. We present the results of an innovative combination of NPWT with a new fascial-approximation technique using dynamic fascial sutures (DFS) and delayed closure of the abdominal wall.
Methods
Eighty-seven patients subjected to OA therapy following surgery for secondary peritonitis were treated with NPWT and DFS. In all patients, a running suture of elastic vessel loops was used to approximate fascial edges. This procedure was continued for the duration of NPWT until final closure of the abdomen with running suture in 55 patients (63.2 %) and interrupted suture technique in eight patients (9.2 %). An anterior component separation was performed in seven patients.
Results
Delayed closure was achieved in 68 patients (78.2 %) after 12.6 days [mean (SD) 25.1 (2–204)] days and 4.3 re-operations [mean (SD) 6.0 (1–43)]. Fifteen (17.2 %) superficial and two (2.3 %) deep wound infections occurred. In three (3.4 %) cases, entero-atmospheric fistulas had to be treated. We recorded no technique-specific complications. Four (5.9 %) incisional hernia were detected in a mean follow-up of 40.5 months (16–65). Mortality rate was 55.2 %.
Conclusion
Using a new technique combining NPWT and DFS in the treatment of the OA, the delayed closure of the fascial edges by running suture can be achieved and the number of re-operations can be kept low. The technique was safe and led to a low incidence of incisional hernias. Extensive abdominal wall reconstruction was seldom required.</description><subject>Abdomen</subject><subject>Abdomen - surgery</subject><subject>Abdominal Surgery</subject><subject>Abdominal Wound Closure Techniques</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Approximation</subject><subject>Austria - epidemiology</subject><subject>Fasciotomy</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Gastroenterology</subject><subject>Gynecology</subject><subject>Hepatology</subject><subject>Hernias</subject><subject>Humans</subject><subject>Infections</subject><subject>Laparotomy - adverse effects</subject><subject>Leukocytes</subject><subject>Male</subject><subject>Medical personnel</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Negative-Pressure Wound Therapy - methods</subject><subject>Peritonitis</subject><subject>Peritonitis - surgery</subject><subject>Proctology</subject><subject>Prospective Studies</subject><subject>Reoperation</subject><subject>Sepsis - etiology</subject><subject>Surgery</subject><subject>Surgical Wound Infection - complications</subject><subject>Surgical Wound Infection - mortality</subject><subject>Surgical Wound Infection - therapy</subject><subject>Survival Rate - trends</subject><subject>Suture Techniques</subject><subject>Sutures</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><subject>Wound healing</subject><issn>0930-2794</issn><issn>1432-2218</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp1kc1qFjEUhoMo9mv1AtxIwI2b0fzPZCmtVqHgRtchyZypKTPJmGSUuQMv23x-VURwdQ7keZ8ceBF6RskrSkj_uhAilOgI5R1nknbqATpQwVnHGB0eogPRnHSs1-IMnZdyRxquqXyMzpigQg9SHtCPK5jtDiP2cypbBpwmnFaI2LoxLW2GiAusNXi82hog1oJDwZP1YQ7V1pZ0O_ZpcSG2PcJto74BXjOUX77vaYsjrl8g23XHtu3jHu3SfJMtPtgZl6028Al6NNm5wNP7eYE-v3v76fJ9d_Px-sPlm5vO857VTnoqldCaKcG8G6lmsu-9JiAZqFGNgkyOcUekU1xoZvXQ-8HyXlPLJjdRfoFenrxrTl83KNUsoXiYZxshbcVQSejA-2GQDX3xD3qXthzbdUeKaKKVZo2iJ8rnVEqGyaw5LDbvhhJzrMmcajKtJnOsyaiWeX5v3twC45_E714awE5AaU_xFvJfX__X-hPASp44</recordid><startdate>20140301</startdate><enddate>20140301</enddate><creator>Fortelny, René H.</creator><creator>Hofmann, Anna</creator><creator>Gruber-Blum, Simone</creator><creator>Petter-Puchner, Alexander H.</creator><creator>Glaser, Karl S.</creator><general>Springer US</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20140301</creationdate><title>Delayed closure of open abdomen in septic patients is facilitated by combined negative pressure wound therapy and dynamic fascial suture</title><author>Fortelny, René H. ; Hofmann, Anna ; Gruber-Blum, Simone ; Petter-Puchner, Alexander H. ; Glaser, Karl S.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c372t-5c1564992642cbd192577c90e52e6d6d40fb23b05b63492a987c8a3791a2fbf13</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Abdomen</topic><topic>Abdomen - surgery</topic><topic>Abdominal Surgery</topic><topic>Abdominal Wound Closure Techniques</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Approximation</topic><topic>Austria - epidemiology</topic><topic>Fasciotomy</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Gastroenterology</topic><topic>Gynecology</topic><topic>Hepatology</topic><topic>Hernias</topic><topic>Humans</topic><topic>Infections</topic><topic>Laparotomy - adverse effects</topic><topic>Leukocytes</topic><topic>Male</topic><topic>Medical personnel</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Negative-Pressure Wound Therapy - methods</topic><topic>Peritonitis</topic><topic>Peritonitis - surgery</topic><topic>Proctology</topic><topic>Prospective Studies</topic><topic>Reoperation</topic><topic>Sepsis - etiology</topic><topic>Surgery</topic><topic>Surgical Wound Infection - complications</topic><topic>Surgical Wound Infection - mortality</topic><topic>Surgical Wound Infection - therapy</topic><topic>Survival Rate - trends</topic><topic>Suture Techniques</topic><topic>Sutures</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><topic>Wound healing</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Fortelny, René H.</creatorcontrib><creatorcontrib>Hofmann, Anna</creatorcontrib><creatorcontrib>Gruber-Blum, Simone</creatorcontrib><creatorcontrib>Petter-Puchner, Alexander H.</creatorcontrib><creatorcontrib>Glaser, Karl S.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Surgical endoscopy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Fortelny, René H.</au><au>Hofmann, Anna</au><au>Gruber-Blum, Simone</au><au>Petter-Puchner, Alexander H.</au><au>Glaser, Karl S.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Delayed closure of open abdomen in septic patients is facilitated by combined negative pressure wound therapy and dynamic fascial suture</atitle><jtitle>Surgical endoscopy</jtitle><stitle>Surg Endosc</stitle><addtitle>Surg Endosc</addtitle><date>2014-03-01</date><risdate>2014</risdate><volume>28</volume><issue>3</issue><spage>735</spage><epage>740</epage><pages>735-740</pages><issn>0930-2794</issn><eissn>1432-2218</eissn><abstract>Introduction
The aim of this prospective controlled trial was the definition of the optimal timepoint for delayed closure after negative pressure wound therapy (NPWT) in the treatment of the open abdomen (OA) in septic patients after abdominal surgery. The delayed closure of the abdominal wall after abdominal NPWT treatment is often problematic due to the lateralization of the fascial edge leading to unfavorably high tensile forces of the adapting sutures in the midline. We present the results of an innovative combination of NPWT with a new fascial-approximation technique using dynamic fascial sutures (DFS) and delayed closure of the abdominal wall.
Methods
Eighty-seven patients subjected to OA therapy following surgery for secondary peritonitis were treated with NPWT and DFS. In all patients, a running suture of elastic vessel loops was used to approximate fascial edges. This procedure was continued for the duration of NPWT until final closure of the abdomen with running suture in 55 patients (63.2 %) and interrupted suture technique in eight patients (9.2 %). An anterior component separation was performed in seven patients.
Results
Delayed closure was achieved in 68 patients (78.2 %) after 12.6 days [mean (SD) 25.1 (2–204)] days and 4.3 re-operations [mean (SD) 6.0 (1–43)]. Fifteen (17.2 %) superficial and two (2.3 %) deep wound infections occurred. In three (3.4 %) cases, entero-atmospheric fistulas had to be treated. We recorded no technique-specific complications. Four (5.9 %) incisional hernia were detected in a mean follow-up of 40.5 months (16–65). Mortality rate was 55.2 %.
Conclusion
Using a new technique combining NPWT and DFS in the treatment of the OA, the delayed closure of the fascial edges by running suture can be achieved and the number of re-operations can be kept low. The technique was safe and led to a low incidence of incisional hernias. Extensive abdominal wall reconstruction was seldom required.</abstract><cop>Boston</cop><pub>Springer US</pub><pmid>24149855</pmid><doi>10.1007/s00464-013-3251-6</doi><tpages>6</tpages></addata></record> |
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subjects | Abdomen Abdomen - surgery Abdominal Surgery Abdominal Wound Closure Techniques Adult Aged Aged, 80 and over Approximation Austria - epidemiology Fasciotomy Female Follow-Up Studies Gastroenterology Gynecology Hepatology Hernias Humans Infections Laparotomy - adverse effects Leukocytes Male Medical personnel Medicine Medicine & Public Health Middle Aged Mortality Negative-Pressure Wound Therapy - methods Peritonitis Peritonitis - surgery Proctology Prospective Studies Reoperation Sepsis - etiology Surgery Surgical Wound Infection - complications Surgical Wound Infection - mortality Surgical Wound Infection - therapy Survival Rate - trends Suture Techniques Sutures Time Factors Treatment Outcome Wound healing |
title | Delayed closure of open abdomen in septic patients is facilitated by combined negative pressure wound therapy and dynamic fascial suture |
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