Vacuum-assisted wound closure and mesh-mediated fascial traction for open abdomen therapy - a systematic review.

Abstract

BACKGROUND:

The aim of this paper was to review the literature on vacuum-assisted wound closure and mesh-mediated fascial traction (VAWCM) in open abdomen therapy. It was designed as systematic review of observational studies.

METHODS:

A Pub Med, EMBASE and Cochrane search from 2007/01-2016/07 was performed combining the Medical Subject Headings "vacuum", "mesh-mediated fascial traction", "temporary abdominal closure", "delayed abdominal closure", "open abdomen", "abdominal compartment syndrome", "negative pressure wound therapy" or "vacuum assisted wound closure".

RESULTS:

Eleven original studies were found including patients numbering from 7 to 111. Six studies were prospective and five were retrospective. Nine studies were on mixed surgical (n = 9), vascular (n = 6) and trauma (n = 6) patients, while two were exclusively on vascular patients. The primary fascial closure rate per protocol varied from 80-100%. The time to closure of the open abdomen varied between 9-32 days. The entero-atmospheric fistula rate varied from 0-10.0%. The in-hospital survival rate varied from 57-100%. In the largest prospective study, the incisional hernia rate among survivors at 63 months of median follow-up was 54% (27/50), and 16 (33%) repairs out of 48 incisional hernias were performed throughout the study period. The study patients reported lower short form health survey (SF-36) scores than the mean reference population, mainly dependent on the prevalence of major co-morbidities. There was no difference in SF-36 scores or a modified ventral hernia pain questionnaire (VHPQ) at 5 years of follow up between those with versus those without incisional hernias.

CONCLUSIONS:

A high primary fascial closure rate can be achieved with the vacuum-assisted wound closure and meshmediated fascial traction technique in elderly, mainly non-trauma patients, in need of prolonged open abdomen therapy.

• Authors: Stefan Acosta, Martin Björck, Ulf Petersson
• Journal: Anaesthesiology intensive therapy (Anaesthesiol Intensive Ther) Vol. 49 Issue 2 Pg. 139-145 ( 2017) ISSN: 1731-2531 [Electronic] Poland
• PMID: 28502075 (Publication Type: Journal Article, Review, Systematic Review)

Topics

• Abdomen (surgery)
• Abdominal Wound Closure Techniques (instrumentation)
• Aged
• Humans
• Surgical Mesh
• Time Factors
• Traction
• Vacuum
• Wound Healing