Treatment of the Open Abdomen with the Commercially Available Vacuum-Assisted Closure System in Patients with Abdominal Sepsis: Low Primary Closure Rate
Background Abdominal Vacuum-Assisted Closure (V.A.C.) systems for treatment of open abdomens have been predominantly used for trauma patients with a high primary fascial closure rate. Use of the V.A.C. technique in abdominal sepsis is less well established. Methods All patients with abdominal sepsis...
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| Veröffentlicht in: | World journal of surgery 2008-12, Vol.32 (12), p.2724-2729 |
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| creator | Wondberg, D. Larusson, H. J. Metzger, U. Platz, A. Zingg, U. |
| description | Background
Abdominal Vacuum-Assisted Closure (V.A.C.) systems for treatment of open abdomens have been predominantly used for trauma patients with a high primary fascial closure rate. Use of the V.A.C. technique in abdominal sepsis is less well established.
Methods
All patients with abdominal sepsis and treatment with the abdominal V.A.C. system between 2004 and 2007 were prospectively assessed. End points were fascial closure, V.A.C.-related morbidity, and quality of life score (SF-36) at follow-up.
Results
Thirty patients with abdominal sepsis were included in the study. Primary fascial closure was feasible in 10, partial closure in 4, and no closure in 16 patients. Median number of V.A.C. changes was 3 (range, 1–10). Nine patients died. V.A.C.-related morbidity was as follows: two fistulas, three fascial edge necroses, one skin blister, and four prolapses of small bowel between the fascia and foam. Univariate analysis showed no variables influencing primary closure rate or V.A.C.-related morbidity. Mortality was significantly influenced by age (
P
|
| doi_str_mv | 10.1007/s00268-008-9762-y |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_69798001</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>69798001</sourcerecordid><originalsourceid>FETCH-LOGICAL-c266y-15f1cd6f416cbaa6729ae2bccbd30fda6654244ae3c7f05db2602171282c057d3</originalsourceid><addsrcrecordid>eNp1kU9v1DAQxS1ERZfCB-CCLKRyS_GfxEmOqxUFpEpFauFqTZwJdeUkiycpyoXPjrdZUQmJk-3x770ZzWPsjRQXUojyAwmhTJUJUWV1aVS2PGMbmWuVKa30c7YR2uTpLvUpe0l0L4QsjTAv2KmsKm2SYsN-30aEqcdh4mPHpzvk13sc-LZpx1Tkv_x091jdjX2P0XkIYeHbB_ABmoD8O7h57rMtkacJW74LI80R-c2Snj33A_8Kk0_utFo9-voBAr_BfdK8YicdBMLXx_OMfbv8eLv7nF1df_qy215lThmzZLLopGtNl0vjGgBTqhpQNc41rRZdC8YUucpzQO3KThRto4xQspSqUk4UZavP2PvVdx_HnzPSZHtPDkOAAceZrKnLukr7SeC7f8D7cY5pYLJK1rUpitwkSK6QiyNRxM7uo-8hLlYKe0jGrsnYlIw9JGOXpHl7NJ6bHtsnxTGKBJwfASAHoYswOE9_OSXqXOfqwKmVo_Q1_MD4NOH_u_8Bsnmnlw</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>219965546</pqid></control><display><type>article</type><title>Treatment of the Open Abdomen with the Commercially Available Vacuum-Assisted Closure System in Patients with Abdominal Sepsis: Low Primary Closure Rate</title><source>MEDLINE</source><source>Springer Online Journals Complete</source><source>Access via Wiley Online Library</source><creator>Wondberg, D. ; Larusson, H. J. ; Metzger, U. ; Platz, A. ; Zingg, U.</creator><creatorcontrib>Wondberg, D. ; Larusson, H. J. ; Metzger, U. ; Platz, A. ; Zingg, U.</creatorcontrib><description>Background
Abdominal Vacuum-Assisted Closure (V.A.C.) systems for treatment of open abdomens have been predominantly used for trauma patients with a high primary fascial closure rate. Use of the V.A.C. technique in abdominal sepsis is less well established.
Methods
All patients with abdominal sepsis and treatment with the abdominal V.A.C. system between 2004 and 2007 were prospectively assessed. End points were fascial closure, V.A.C.-related morbidity, and quality of life score (SF-36) at follow-up.
Results
Thirty patients with abdominal sepsis were included in the study. Primary fascial closure was feasible in 10, partial closure in 4, and no closure in 16 patients. Median number of V.A.C. changes was 3 (range, 1–10). Nine patients died. V.A.C.-related morbidity was as follows: two fistulas, three fascial edge necroses, one skin blister, and four prolapses of small bowel between the fascia and foam. Univariate analysis showed no variables influencing primary closure rate or V.A.C.-related morbidity. Mortality was significantly influenced by age (
P
< 0.001), respiratory failure (
P
= 0.01), and pneumonia (
P
= 0.03). At follow-up, V.A.C. patients scored lower in the physical health scores and similar in the mental health scores compared with the normal population.
Conclusions
Treatment of the open abdomen in patients with abdominal sepsis with the abdominal V.A.C. system is safe with good long-term quality of life. Primary closure rate in these patients is substantially lower than in trauma patients. Stepwise closure of the fascia during V.A.C. changes should be attempted to avoid additional lateral retraction of fascial edges. V.A.C.-related complications may be avoided with careful surgical technique.</description><identifier>ISSN: 0364-2313</identifier><identifier>EISSN: 1432-2323</identifier><identifier>DOI: 10.1007/s00268-008-9762-y</identifier><identifier>PMID: 18836762</identifier><identifier>CODEN: WJSUDI</identifier><language>eng</language><publisher>New York: Springer-Verlag</publisher><subject>Abdominal Surgery ; Abdominal Wall - surgery ; Adult ; Aged ; Aged, 80 and over ; Bacterial diseases ; Bacterial sepsis ; Biological and medical sciences ; Cardiac Surgery ; Cohort Studies ; Equipment Design ; Fasciotomy ; Female ; General aspects ; General Surgery ; Human bacterial diseases ; Humans ; Infectious diseases ; Laparotomy - adverse effects ; Male ; Medical sciences ; Medicine ; Medicine & Public Health ; Middle Aged ; Negative-Pressure Wound Therapy - instrumentation ; Peritonitis - diagnosis ; Peritonitis - etiology ; Peritonitis - therapy ; Polyurethanes ; Retrospective Studies ; Sepsis - diagnosis ; Sepsis - etiology ; Sepsis - therapy ; Surgery ; Surgical Wound Infection - diagnosis ; Surgical Wound Infection - etiology ; Surgical Wound Infection - therapy ; Thoracic Surgery ; Treatment Outcome ; Vascular Surgery</subject><ispartof>World journal of surgery, 2008-12, Vol.32 (12), p.2724-2729</ispartof><rights>Société Internationale de Chirurgie 2008</rights><rights>2009 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c266y-15f1cd6f416cbaa6729ae2bccbd30fda6654244ae3c7f05db2602171282c057d3</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/s00268-008-9762-y$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00268-008-9762-y$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>315,781,785,27929,27930,41493,42562,51324</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=20943422$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/18836762$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Wondberg, D.</creatorcontrib><creatorcontrib>Larusson, H. J.</creatorcontrib><creatorcontrib>Metzger, U.</creatorcontrib><creatorcontrib>Platz, A.</creatorcontrib><creatorcontrib>Zingg, U.</creatorcontrib><title>Treatment of the Open Abdomen with the Commercially Available Vacuum-Assisted Closure System in Patients with Abdominal Sepsis: Low Primary Closure Rate</title><title>World journal of surgery</title><addtitle>World J Surg</addtitle><addtitle>World J Surg</addtitle><description>Background
Abdominal Vacuum-Assisted Closure (V.A.C.) systems for treatment of open abdomens have been predominantly used for trauma patients with a high primary fascial closure rate. Use of the V.A.C. technique in abdominal sepsis is less well established.
Methods
All patients with abdominal sepsis and treatment with the abdominal V.A.C. system between 2004 and 2007 were prospectively assessed. End points were fascial closure, V.A.C.-related morbidity, and quality of life score (SF-36) at follow-up.
Results
Thirty patients with abdominal sepsis were included in the study. Primary fascial closure was feasible in 10, partial closure in 4, and no closure in 16 patients. Median number of V.A.C. changes was 3 (range, 1–10). Nine patients died. V.A.C.-related morbidity was as follows: two fistulas, three fascial edge necroses, one skin blister, and four prolapses of small bowel between the fascia and foam. Univariate analysis showed no variables influencing primary closure rate or V.A.C.-related morbidity. Mortality was significantly influenced by age (
P
< 0.001), respiratory failure (
P
= 0.01), and pneumonia (
P
= 0.03). At follow-up, V.A.C. patients scored lower in the physical health scores and similar in the mental health scores compared with the normal population.
Conclusions
Treatment of the open abdomen in patients with abdominal sepsis with the abdominal V.A.C. system is safe with good long-term quality of life. Primary closure rate in these patients is substantially lower than in trauma patients. Stepwise closure of the fascia during V.A.C. changes should be attempted to avoid additional lateral retraction of fascial edges. V.A.C.-related complications may be avoided with careful surgical technique.</description><subject>Abdominal Surgery</subject><subject>Abdominal Wall - surgery</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Bacterial diseases</subject><subject>Bacterial sepsis</subject><subject>Biological and medical sciences</subject><subject>Cardiac Surgery</subject><subject>Cohort Studies</subject><subject>Equipment Design</subject><subject>Fasciotomy</subject><subject>Female</subject><subject>General aspects</subject><subject>General Surgery</subject><subject>Human bacterial diseases</subject><subject>Humans</subject><subject>Infectious diseases</subject><subject>Laparotomy - adverse effects</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Negative-Pressure Wound Therapy - instrumentation</subject><subject>Peritonitis - diagnosis</subject><subject>Peritonitis - etiology</subject><subject>Peritonitis - therapy</subject><subject>Polyurethanes</subject><subject>Retrospective Studies</subject><subject>Sepsis - diagnosis</subject><subject>Sepsis - etiology</subject><subject>Sepsis - therapy</subject><subject>Surgery</subject><subject>Surgical Wound Infection - diagnosis</subject><subject>Surgical Wound Infection - etiology</subject><subject>Surgical Wound Infection - therapy</subject><subject>Thoracic Surgery</subject><subject>Treatment Outcome</subject><subject>Vascular Surgery</subject><issn>0364-2313</issn><issn>1432-2323</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2008</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp1kU9v1DAQxS1ERZfCB-CCLKRyS_GfxEmOqxUFpEpFauFqTZwJdeUkiycpyoXPjrdZUQmJk-3x770ZzWPsjRQXUojyAwmhTJUJUWV1aVS2PGMbmWuVKa30c7YR2uTpLvUpe0l0L4QsjTAv2KmsKm2SYsN-30aEqcdh4mPHpzvk13sc-LZpx1Tkv_x091jdjX2P0XkIYeHbB_ABmoD8O7h57rMtkacJW74LI80R-c2Snj33A_8Kk0_utFo9-voBAr_BfdK8YicdBMLXx_OMfbv8eLv7nF1df_qy215lThmzZLLopGtNl0vjGgBTqhpQNc41rRZdC8YUucpzQO3KThRto4xQspSqUk4UZavP2PvVdx_HnzPSZHtPDkOAAceZrKnLukr7SeC7f8D7cY5pYLJK1rUpitwkSK6QiyNRxM7uo-8hLlYKe0jGrsnYlIw9JGOXpHl7NJ6bHtsnxTGKBJwfASAHoYswOE9_OSXqXOfqwKmVo_Q1_MD4NOH_u_8Bsnmnlw</recordid><startdate>200812</startdate><enddate>200812</enddate><creator>Wondberg, D.</creator><creator>Larusson, H. J.</creator><creator>Metzger, U.</creator><creator>Platz, A.</creator><creator>Zingg, U.</creator><general>Springer-Verlag</general><general>Springer</general><general>Springer Nature B.V</general><scope>IQODW</scope><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>7QO</scope><scope>7T5</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>200812</creationdate><title>Treatment of the Open Abdomen with the Commercially Available Vacuum-Assisted Closure System in Patients with Abdominal Sepsis</title><author>Wondberg, D. ; Larusson, H. J. ; Metzger, U. ; Platz, A. ; Zingg, U.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c266y-15f1cd6f416cbaa6729ae2bccbd30fda6654244ae3c7f05db2602171282c057d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2008</creationdate><topic>Abdominal Surgery</topic><topic>Abdominal Wall - surgery</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Bacterial diseases</topic><topic>Bacterial sepsis</topic><topic>Biological and medical sciences</topic><topic>Cardiac Surgery</topic><topic>Cohort Studies</topic><topic>Equipment Design</topic><topic>Fasciotomy</topic><topic>Female</topic><topic>General aspects</topic><topic>General Surgery</topic><topic>Human bacterial diseases</topic><topic>Humans</topic><topic>Infectious diseases</topic><topic>Laparotomy - adverse effects</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Negative-Pressure Wound Therapy - instrumentation</topic><topic>Peritonitis - diagnosis</topic><topic>Peritonitis - etiology</topic><topic>Peritonitis - therapy</topic><topic>Polyurethanes</topic><topic>Retrospective Studies</topic><topic>Sepsis - diagnosis</topic><topic>Sepsis - etiology</topic><topic>Sepsis - therapy</topic><topic>Surgery</topic><topic>Surgical Wound Infection - diagnosis</topic><topic>Surgical Wound Infection - etiology</topic><topic>Surgical Wound Infection - therapy</topic><topic>Thoracic Surgery</topic><topic>Treatment Outcome</topic><topic>Vascular Surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Wondberg, D.</creatorcontrib><creatorcontrib>Larusson, H. J.</creatorcontrib><creatorcontrib>Metzger, U.</creatorcontrib><creatorcontrib>Platz, A.</creatorcontrib><creatorcontrib>Zingg, U.</creatorcontrib><collection>Pascal-Francis</collection><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>Biotechnology Research Abstracts</collection><collection>Immunology Abstracts</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>Technology Research Database</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>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Biotechnology and BioEngineering Abstracts</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>World journal of surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Wondberg, D.</au><au>Larusson, H. J.</au><au>Metzger, U.</au><au>Platz, A.</au><au>Zingg, U.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Treatment of the Open Abdomen with the Commercially Available Vacuum-Assisted Closure System in Patients with Abdominal Sepsis: Low Primary Closure Rate</atitle><jtitle>World journal of surgery</jtitle><stitle>World J Surg</stitle><addtitle>World J Surg</addtitle><date>2008-12</date><risdate>2008</risdate><volume>32</volume><issue>12</issue><spage>2724</spage><epage>2729</epage><pages>2724-2729</pages><issn>0364-2313</issn><eissn>1432-2323</eissn><coden>WJSUDI</coden><abstract>Background
Abdominal Vacuum-Assisted Closure (V.A.C.) systems for treatment of open abdomens have been predominantly used for trauma patients with a high primary fascial closure rate. Use of the V.A.C. technique in abdominal sepsis is less well established.
Methods
All patients with abdominal sepsis and treatment with the abdominal V.A.C. system between 2004 and 2007 were prospectively assessed. End points were fascial closure, V.A.C.-related morbidity, and quality of life score (SF-36) at follow-up.
Results
Thirty patients with abdominal sepsis were included in the study. Primary fascial closure was feasible in 10, partial closure in 4, and no closure in 16 patients. Median number of V.A.C. changes was 3 (range, 1–10). Nine patients died. V.A.C.-related morbidity was as follows: two fistulas, three fascial edge necroses, one skin blister, and four prolapses of small bowel between the fascia and foam. Univariate analysis showed no variables influencing primary closure rate or V.A.C.-related morbidity. Mortality was significantly influenced by age (
P
< 0.001), respiratory failure (
P
= 0.01), and pneumonia (
P
= 0.03). At follow-up, V.A.C. patients scored lower in the physical health scores and similar in the mental health scores compared with the normal population.
Conclusions
Treatment of the open abdomen in patients with abdominal sepsis with the abdominal V.A.C. system is safe with good long-term quality of life. Primary closure rate in these patients is substantially lower than in trauma patients. Stepwise closure of the fascia during V.A.C. changes should be attempted to avoid additional lateral retraction of fascial edges. V.A.C.-related complications may be avoided with careful surgical technique.</abstract><cop>New York</cop><pub>Springer-Verlag</pub><pmid>18836762</pmid><doi>10.1007/s00268-008-9762-y</doi><tpages>6</tpages></addata></record> |
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| ispartof | World journal of surgery, 2008-12, Vol.32 (12), p.2724-2729 |
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| source | MEDLINE; Springer Online Journals Complete; Access via Wiley Online Library |
| subjects | Abdominal Surgery Abdominal Wall - surgery Adult Aged Aged, 80 and over Bacterial diseases Bacterial sepsis Biological and medical sciences Cardiac Surgery Cohort Studies Equipment Design Fasciotomy Female General aspects General Surgery Human bacterial diseases Humans Infectious diseases Laparotomy - adverse effects Male Medical sciences Medicine Medicine & Public Health Middle Aged Negative-Pressure Wound Therapy - instrumentation Peritonitis - diagnosis Peritonitis - etiology Peritonitis - therapy Polyurethanes Retrospective Studies Sepsis - diagnosis Sepsis - etiology Sepsis - therapy Surgery Surgical Wound Infection - diagnosis Surgical Wound Infection - etiology Surgical Wound Infection - therapy Thoracic Surgery Treatment Outcome Vascular Surgery |
| title | Treatment of the Open Abdomen with the Commercially Available Vacuum-Assisted Closure System in Patients with Abdominal Sepsis: Low Primary Closure Rate |
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