Department for General and Abdominal Surgery, Maria-Hilf Hospital, Brilon, Germany.
Department for Vascular Surgery, St. Vinzenz-Hospital, Cologne, Germany.
Surg Technol Int. 2024 Jul 15;44:131-137. doi: 10.52198/24.STI.44.HR1781.
Open abdomen (OA) is a well-established procedure for life-threatening illnesses such as septic peritonitis, abdominal compartment syndrome (ACS), and damage control surgery (DCS). Furthermore, in cases of life-saving aortic repair after perforation of abdominal aortic aneurysm, an OA is sometimes indicated. Definitive fascial closure (DFC) is one of the main goals during treatment to prevent further complications such as fistula formation and the development of an incisional hernia. In 2019, a new technique was introduced for OA using a device called fasciotens®Abdomen to apply dynamic traction to the abdominal wall through vertical mesh-mediated fascial traction (VMMFT). We present a case series including nine patients and show an algorithm for OA combining VMMFT and negative pressure wound therapy (NPWT).
Two patients in a vascular surgery unit and seven patients in an abdominal surgery unit with an OA were treated with VMMFT in combination with NPWT between September 2019 and June 2023.
A DFC was achieved in seven of nine cases. The mean duration of OA was 9.6 ± 3.8 days, and fascial dehiscence at the beginning of OA was 14.2 ± 4.0 cm on average. Time to DFC after VMMFT was established was 6.2 ± 3.5 days (mean). No method-related complications occurred.
The standardized combination of VMMFT and NPWT gave positive results in achieving DFC in our heterogenic patient group. Following a strict treatment pathway as shown here seems to improve OA outcome. It represents a promising further development of mesh-mediated fascial traction for OA treatment.
开放式腹部（OA）是一种成熟的手术方法，适用于危及生命的疾病，如脓毒性腹膜炎、腹腔间隔室综合征（ACS）和损伤控制性手术（DCS）。此外，在腹部主动脉瘤穿孔后进行挽救生命的主动脉修复时，有时也需要 OA。确定性筋膜闭合（DFC）是治疗过程中的主要目标之一，以防止进一步的并发症，如瘘管形成和切口疝的发展。2019 年，一种新的技术被引入，即使用 fasciotens®Abdomen 设备进行 OA，通过垂直网片介导的筋膜牵引（VMMFT）对腹壁施加动态牵引。我们报告了一个包括 9 例患者的病例系列，并展示了一种将 VMMFT 与负压伤口治疗（NPWT）相结合的 OA 算法。
2019 年 9 月至 2023 年 6 月，血管外科病房的 2 例患者和腹部外科病房的 7 例患者接受了 VMMFT 联合 NPWT 治疗。
9 例中有 7 例实现了 DFC。OA 的平均持续时间为 9.6±3.8 天，OA 开始时筋膜裂开的平均长度为 14.2±4.0cm。在建立 VMMFT 后达到 DFC 的时间为 6.2±3.5 天（平均值）。没有发生与方法相关的并发症。
在我们的异质患者群体中，VMMFT 和 NPWT 的标准化联合在实现 DFC 方面取得了积极的结果。按照这里所示的严格治疗路径似乎可以改善 OA 的结果。这代表了一种有前途的进一步发展，用于 OA 治疗的网片介导的筋膜牵引。
