Accelerated Open Abdomen Treatment
Maria-Hilf Hospital Brilon, Germany - December 2024
Thomas Mones applied fasciotens®Abdomen early on a patient after an emergency surgery. The results show how the patients benefit from immediate vertical fascial traction during the open abdomen treatment.
Starting the open abdomen treatment
The patient was admitted to the emergency room with an acute abdomen with a stenosis of the sigma that led to a 3 cm wide perforation of the caecum and a general peritonitis.
A right hemicolectomy with an end ileostomy and an end colostomy was performed.
The decision was made to leave the abdomen open. After an extended lavage, the abdomen was covered with a visceral protection layer and an abdominal negative pressure wound therapy (NPWT).
After 48h, the abdominal cavity appeared clean, but a large edema had developed. The therapy with visceral protection layer and NPWT was continued and additionally combined with vertical mesh-mediated fascial traction. Therefore, fasciotens®Abdomen was applied according to the published algorithm: "Vertical Mesh-Mediated Fascial Traction and Negative Pressure Wound Therapy: A Case Series of Nine Patients in General and Vascular Surgery".
How to prepare for vertical mesh-mediated fascial traction
The applied vertical traction is distributed by two doubled mesh strips to which six traction sutures (braided USP 2) are attached per side. Watch the video to see how it works.
The combination of NPWT and vertical mesh-mediated fascial traction
The following steps were performed during each relook surgery:
- Extensive lavage
- Visceral protection layer
- NPWT
To ensure the adhesive dressing of the NPWT system in combination with the traction sutures is airtight, the surgeons used a special procedure which we call the sandwich technique.
Watch the video to get a first impression. If you want to see the NPWT application in detail, go to our How to section to see the video in full length.
Device application
Once the NPWT is airtight, fasciotens®Abdomen can be applied in the OR/ICU.
The device stays on the patient for approximately 5 hours before a 1-hour break. During the break, regular nursing routines can be performed.
A close collaboration between surgeons and the ICU teams is essential to ensure everybody is on board.
Watch the video to see how the device was applied by the surgical residents.
Closure after 13 days
In total, 4 relook surgeries were performed due to the prolonged edema. The early vertical fascial traction prevented fascial retraction and kept intra-abdominal pressure low during treatment. Definitive abdominal wall closure was achieved effortlessly 13 days after the index surgery. After 5 more days of subcuteanous NPWT the skin was closed.
The video shows the closure of the abdominal wall.
Discharge 5 weeks after emergency surgery
The patient recovered very quickly after successful abdominal wall closure. He was discharged 5 weeks after the initial emergency surgery.
However, the surgeons abandoned the original plan to reconstruct the bowel during the same stay due to pronounced adhesions.
5 weeks after discharge
The patient was scheduled for a follow-up consultation and reported that he can manage everyday routines on his own.
Outcomes
- Conclusion
- Patient statement
- Next steps
Satisfying Outcomes
The patient was extubated shortly after abdominal wall closure and was transferred to the regular ward. He was discharged 5 weeks after the emergency surgery.
Painless treatment
The patient reported having had hardly any pain after the treatment. He is very relieved that a planned incisional hernia could be avoided.
Reversal of colostomy and ileostomy
Due to pronounced adhesions the surgeons decided to leave the reversal of the stomata to a later point. The patient will come back for surgery within the following year.
What to expect in the ICU
The surgical part of the fasciotens®Abdomen is minimal as you could see above. Most of the treatment takes place in the ICU. Therefore, the communication and onboarding of the ICU teams are crucial for a successful treatment.
Watch the 20-minute E-learning course to learn how the product is handled in the ICU.
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