CLOSURE OF OPEN ABDOMENS USING A DYNAMIC FASCIAL CLOSURE DEVICE: A
CASE SERIES
Stephen Von MD, Cyrus A. Kotwall MD, William W. Hope MD
Department of Surgery, New Hanover Regional Medical Center, Wilmington, North Carolina
Damage control surgery has gained widespread acceptance for severely injured patients and in patients with abdominal compartment syndrome. Although these concepts have lead to increased survival it has led to a new dilemma of abdominal closure for surgeons caring for these patients. The ABRA® abdominal wall closure system is a novel device that may aid in abdominal wall closure.
We present four cases of male patients with open abdomens with an average age of 50 years. The first patient suffered a work related crush injury and underwent damage control laparotomy secondary to mesenteric bleeding and hemoperitoneum. He underwent abdominal closure the following day but had to be reopened at the bedside for abdominal compartment syndrome. He then had placement of the ABRA® device achieving primary closure 6 days later. The second patient was involved in a motor vehicle crash and required damage control laparotomy for a missed small bowel injury. The patient underwent abdominal closure the next day but had a dehiscence/evisceration 6 days following. The patient had the
ABRA® placed with primary closure on postoperative day 6. The third patient was involved in a powerchute crash with multitrauma and developed an ischemic right colon 7 days following the crash requiring damage control laparotomy. After multiple abdominal washouts, the patient ultimately had an
ABRA® placed achieving primary closure 5 days after placement. The last patient had an exploratory laparotomy and drainage of multiple abdominal and liver abscesses with his abdomen left open. Five days after, he underwent ABRA® placement with subsequent abdominal closure 7 days later. Average operating room time for ABRA® placement was 67 minutes with an average blood loss of 44ml. Average time from placement to abdominal closure was 5.8 days. There has been no abdominal wall morbidity or recurrences noted at an average of 19 months follow-up.
The ABRA® abdominal wall closure system may aid in primary closure in patients with open abdomens, however further study is needed to fully determine the hernia rate associated.