Open Abdominal Management for Prevention of the Development of Enterocutaneous Fistula and Early Fascial Closure

Abstract

Although the concept of damage control and an improved understanding of the pathophysiology of the abdominal compartment syndrome have represented great advances in the management of both traumatic and non-traumatic surgical conditions, many patients require open abdominal management. We evaluated the effect of vacuum pack closure as a temporary abdominal wall closure technique and the anterior rectus abdominis sheath turnover flap method for early fascial closure in patients requiring open abdominal management (OAM). Methods : Fifty-four patients (21 trauma and 33 non-trauma) requiring OAM were reviewed. Results : The mean duration of OAM was 13.9 days and 12 trauma and 15 non-trauma patients survived. There were no cases that developed enteric fistula or abdominal abscess. After the introduction of vacuum pack closure, extension of the interval between the initial surgery and formal abdominal wall closure was observed. Anterior rectus sheath turnover flaps were used in 11 patients who were unsuitable for standard fascial closure due to of prolonged visceral edema. Of these, wound infection developed in 4 and of 10 survivors who did not develop fascial dehiscence or herniation. Conclusions : Vacuum pack closure and early fascial closure using the anterior rectus sheath turnover method may prevent the development of enterocutaneous fistula and reduce the need for skin grafting and later abdominal wall reconstruction in the early management of patients with OAM.