One hundred percent fascial approximation with sequential abdominal closure of the open abdomen

Modern management of complex open abdominal wounds of war: a 5-year experience

BACKGROUND

Optimal management of the open abdomen remains controversial.

STUDY DESIGN

Retrospective review of patients injured during Operations Enduring Freedom and Iraqi Freedom returning to Walter Reed Army Medical Center (WRAMC) from January 2003 to October 2007 for treatment of open abdomen.

RESULTS

Three hundred fifty-four patients were evacuated to WRAMC after laparotomy, including 86 patients (24%) with open abdomen. Three transferred patients were excluded. Eighty-three patients, mean age 26 years (range 18 to 54 years), sustaining injury from secondary blast (n = 47), gunshot (n = 29), and blunt trauma (n = 7) were studied. Surgical management included early definitive abdominal closure (EDAC, n = 56; 67%), primary fascial closure (n = 15; 18%), planned ventral hernia (PVH, n = 9; 11%) and vacuum-assisted closure with AlloDerm (n = 3; 4%). EDAC closure involves serial closure with Gore-Tex Dualmesh and final closure supplemented with polypropylene mesh (62%) or AlloDerm (31%). There was no substantial difference in injury mechanism, age, length of evacuation to WRAMC, or Injury Severity Score (average 30) according to closure type. Complications included removal of infected prosthetic mesh in 4 EDAC closure patients (5%). Overall morbidity was lowest (60%) in primary repair patients (p = 0.01). Rates of deep venous thrombosis, pulmonary embolism, abdominal wall hematoma, and infection did not differ between groups. Fistula rate was increased with PVH (20%). Two patients with PVH died. PVH and EDAC mesh complications have been minimized in the last 2 years of the study.

CONCLUSIONS

Primary closure of fascia is ideal but not always possible. Early definitive closure has avoided PVH. Mesh-related complications have decreased with time.

Soft Tissue Management in Open Fractures of the Lower Leg: The Role of Vacuum Therapy

The management of severe open fractures of the lower leg continues to challenge the treating surgeon. Major difficulties include high infection rates as well as adequate temporary soft tissue coverage. In the past, these injuries were commonly associated with loss of the extremity. Today, vacuum therapy provides not only safe temporary wound coverage but also conditioning of the soft tissues until definitive wound closure. Amongst other advantages, bacterial clearance and increased formation of granulation tissue are attributed to vacuum therapy, making it an extremely attractive tool in the field of wound healing. However, despite its clinical significance, which is underlined by a constantly increasing range of indications, there is a substantial lack of basic research and well-designed studies documenting the superiority of vacuum therapy compared to alternative wound dressings. Vacuum therapy has been approved as an adjunct in the treatment of severe open fractures of the lower leg, complementing repeated surgical debridement and soft tissue coverage by microvascular flaps, which are still crucial in the treatment of these limb-threatening injuries. Vacuum therapy has in general proven useful in the management of soft tissue injuries and, since it is generally well tolerated and has low complication rates, it is fast becoming the gold standard for temporary wound coverage in the treatment of severe open fractures of the lower leg.

The use of the Wittmann Patch facilitates a high rate of fascial closure in severely injured trauma patients and critically ill emergency surgery patients

BACKGROUND

The open abdomen after severe intra-abdominal trauma and emergency surgery is a major operative challenge. It is associated with high morbidity and prolonged hospital stays. Several management strategies have been developed to assist with fascial closure but no single method has emerged as the best. The Wittmann Patch (Starsurgical, Burlington, WI) is a unique device which uses velcro to permit progressive abdominal closure without necessitating serial operations. The purpose of this study was to determine the fascial closure rate using the Wittmann patch. We hypothesized that use of the patch would result in a high closure rate.

METHODS

Hospital billing codes were reviewed to identify those patients who underwent Wittmann patch placement. During the period from June 2002 to May of 2006, 29 patients were identified. These included 19 trauma patients and 10 other surgical patients. Other patients included vascular, bariatric, and emergency general surgery patients. The trauma registry and the patients' medical records were reviewed to determine injury severity, Acute Physiology and Chronic Health Evaluation II scores, fluid requirements, patch placement, management, and patient outcomes.

RESULTS

Twenty-two (76%) of the 29 patients survived to discharge. The average Acute Physiology and Chronic Health Evaluation II score was 25 +/- 6 in all patients, 22.9 +/- 6 in survivors, and 31 +/- 3 in those who died (p = 0.004). Mean injury severity scale and abdominal abbreviated injury scale scores in trauma patients were 28 +/- 10 and 3 +/- 2, respectively. The mean volume of fluid given during the 24 hours before having an open abdomen or patch placement was 17.6 L +/- 10.1 L. Twenty-five (86.2%) of 29 patients had at least one abdominal operation before placement of the patch (mean 1.3 +/- 1.0). Eighteen (82%) of 22 patients who survived to discharge had successful facial closure. Three patients (14%) required mesh placement for abdominal closure. The remaining patient had his patch removed and ultimately underwent skin grafting and subsequent component separation closure. Successful fascial closure was achieved after 15.5 days +/- 10.2 days (range, 5-42 days). The skin was left open in half of the patients. There were four abdominal complications that were noted while the patch was in place. Three of four complications were related to the primary disease, and in the fourth complication the patch became infected and had to be removed. There were no eviscerations or enterocutaneous fistulas after primary fascial closure. The median length of stay was 28 days (Interquartile range, 14-39 days).

CONCLUSIONS

Use of the Wittmann Patch can achieve a high rate of delayed fascial closure in severe trauma and critically ill emergency surgery patients with open abdomens. Most of the complications associated with use of the patch were wound infections after fascial closure and closure of the skin.

A prospective look at the current state of open abdomens

The present study examines the current management, closure rate, and complications of open abdomens in trauma patients admitted to an Academic Level I trauma center between May 2004 and April 2007. Variables examined include mechanism, injuries, use of antibiotics and paralytics, type of abdominal closure, days to closure, complications, ICU and hospital length of stay, and mortality. Stepwise logistic regression was performed to identify independent predictors of failed abdominal closure. Of 900 laparotomies, 93 (10%) were left open. Eighty-five (91%) patients survived for closure opportunity. Definitive fascial closure was achieved in 72 (85%) at 3.9 +/- 3.7 days (range 1-21 days). Of the remaining 13 patients, seven were closed with biologic material, five by skin grafting, and one had skin-only closure. Entero-atmospheric fistulas occurred in 14 (15%) patients. Two independent risk factors associated with failed abdominal closure were the presence of deep surgical site infection [odds ratio (OR) 17.4; 95% confidence interval (CI) 2.6-115.8, P = 0.003] and intra-abdominal abscess (OR 7.4; 95% CI 1.1-51.0, P = 0.04). In conclusion, open abdomens are commonly necessary after trauma laparotomies. Definitive fascial closure can be achieved in 85 per cent of cases. In conjunction with biologics, closure can be achieved in 93 per cent of cases. Failure to primarily close the abdomen is associated with a significantly higher risk for entero-atmospheric fistula occurrence.

Large Gaps of Midline Abdominal Incisions and Their Management

The operative management of midline full-thickness abdominal wall gaps is difficult, often requires several surgical procedures and is associated with significant short- and long-term complications. A rectus abdominis-posterior sheath (RAPS) flap with skin grafting provides a tension-free one-step repair which was used in three patients successfully with midline abdominal wall (including the skin) gaps who had multiple previous operations related to intra-abdominal malignancy. No complications occurred in these patients in relation to this procedure.

Therapy of spinal wound infections using vacuum-assisted wound closure: risk factors leading to resistance to treatment

STUDY DESIGN

This study retrospectively reviewed spine surgical procedures complicated by wound infection and managed by a protocol including the use of vacuum-assisted wound closure (VAC).

OBJECTIVE

To define factors influencing the number of debridements needed before the final wound closure by applying VAC for patients with postoperative spinal wound infections.

SUMMARY OF BACKGROUND DATA

VAC has been suggested as a safe and probably effective method for the treatment of spinal wound infections. The risk factors for infection resistance and need for debridement revisions after VAC placement are unknown.

METHODS

Seventy-three consecutive patients with 79 wound infections after undergoing spine surgery were studied (6 of them had recurrence of infection). All patients were taken to the operating room for irrigation and debridement under general anesthesia followed by placement of the VAC with subsequent delayed closure of the wound. Linear regression and t test were used to identify if the following variables were risk factors for the resistance of infection to VAC treatment: timing of clinical appearance of infection, depth of infection (deep or superficial), presence of instrumentation, positive culture for methicillin-resistant Staphylococcus aureus (MRSA) or more than 1 microorganism, age of the patient, and presence of other comorbidities.

RESULTS

There were 34 males and 39 females with an average age of 58.4 years (21 to 82). Once the VAC was initiated, there was an average of 1.4 procedures until and including closure of the wound. The wound was closed an average of 7 days (range 5 to 14) after the placement of the initial VAC on the wound. The average follow-up was 14 months (range 12 to 28). All of the patients but 2 achieved a clean, closed wound without removal of instrumentation at a minimum follow-up of 1 year. Sixty patients had implants (instrumentation or allograft) within the site of wound infection. Thirteen patients had a decompression with exposed dura. Sixty-four infections (81%) presented with a draining wound within the first 6 weeks postoperatively. Sixty-nine infections (87.3%) were deep below the fascia. There was no statistical significance (P>0.05) of all tested risk factors for the resistance of infection to treatment with the VAC system. The parameter more related to repeat VAC procedures was the culture of MRSA or multiple bacteria.

CONCLUSIONS

VAC therapy may be an effective adjunct in closing spinal wounds even after the repeat procedures. The MRSA or multibacterial infections seem to be most likely to need repeat debridements and VAC treatment before final wound closure.

Long-term outcome of acellular dermal matrix when used for large traumatic open abdomen

BACKGROUND

The purpose of this study is to prospectively examine the use of Human Acellular Dermal Matrix (HADM) in trauma patients with large open abdominal wounds and assess the long-term outcome. Previous studies have not examined the long-term outcomes in trauma patients with abdominal wall reconstructions.

METHODS

An institutional review board approved prospective case series of consecutive patients admitted to a level I university trauma center, who were unable to have their abdomen closed primarily after trauma laparotomy. These patients had HADM placed to attain closure of the abdomen with skin advancement flaps to cover the HADM when possible. Our primary outcome measure was hernia formation and our secondary outcomes were laxity, fistulae, and infections associated with HADM.

RESULTS

Ten patients were enrolled during a 1-year period. Mean time to HADM placement was 17.2 days +/- 3.6 days. Mean initial defect size was 425.1 cm2 +/- 75.9 cm2 with the largest 770 cm2. Thirty day follow-up showed no recurrence in 100% patients. Six patients remained for long-term follow-up. Follow-up at 60 days demonstrated significant laxity or recurrent hernia or both in 67% of patients, and this increased to 100% by the end of 1 year follow-up. There were no bowel fistulae in these patients closed with HADM but 20% with infection.

CONCLUSIONS

HADM is an alternative available to reconstruct the unclosable open abdomen with no fistulae formation, however, it is associated with a high rate of laxity in large abdominal wounds.

Closing the open abdomen: improved success with Wittmann Patch staged abdominal closure

BACKGROUND

Although the "open abdomen" has likely contributed to improved outcomes in trauma patients, the challenge of subsequent fascial closure has emerged. Since mid 2004, we have incorporated Wittmann Patch staged abdominal closure into our management of the open abdomen. The purpose of this study was to evaluate the impact of this device on our incidence of fascial closure versus planned ventral hernia.

METHODS

Patients managed by open abdomen from 2001 through 2006 were identified from the trauma registry. Fascial closure immediately after definitive repair of injuries was defined as "early fascial closure." Continuation of the open abdomen beyond the definitive repair of injuries with subsequent fascial closure was defined as "delayed fascial closure." Since April 2004, the Wittmann Patch was uniformly employed in open abdomen management. Patients managed before the use of this device ("pre-Patch") were compared with those managed in the "Patch" era.

RESULTS

Fifty-six open abdomens were managed in the pre-Patch era and 103 were managed in the Patch era. In the pre-Patch era, 33 (59%) underwent early fascial closure, compared with 67 (65%) in the Patch era (p NS). For the remaining patients, the incidence of delayed fascial closure was significantly higher in those managed with the Wittmann Patch compared with those managed in the pre-Patch era (78% vs. 30%, p < 0.001). Planned ventral hernia was performed in 8 (8%) patients in the Patch era versus 16 (29%) patients in the pre-Patch era (p < 0.001). Abdominal complications were similar between groups (11% vs. 9%, p NS).

CONCLUSIONS

Incorporating the Wittmann Patch into a clinical pathway for management of the open abdomen has contributed to an increased incidence of delayed fascial closure. Abdominal complications were similar in both groups, suggesting that the device is not only efficacious, but also relatively safe.

[Vacuum-assisted abdominal closure: its role in the treatment of complex abdominal and perineal wounds. Experience in 48 patients]

INTRODUCTION

Vacuum-assisted closure (VAC) is a promising approach for the management of complex abdominal and perineal wounds. This paper summarizes our experience with this therapeutic modality and demonstrates its efficacity in difficult situations.

PATIENTS AND METHODS

From January 2003 until December 2005, 48 patients (age 30-89) were treated with VAC therapy for open abdomen, infected laparotomy wounds, or tissue loss due to debridement of Fournier's gangrene. Wound dressings were changed every 2-3 days.

RESULTS

Thirty-eight patients (79%) had major co-morbid conditions liable to impact negatively on wound healing. The treatment duration with VAC varied from 20-30 days with an average of eleven dressing changes (minimum 3-maximum 18). Treatment was effective in all patients. Spontaneous closure was achieved in 36 cases (75%); nine patients (19%) required a split-thickness skin graft, and three (6%) underwent delayed secondary closure.

CONCLUSION

In our institution, VAC has become the treatment of choice for complex abdominal and perineal wounds. It is a safe, simple, and effective technique to speed wound healing and it has reduced the duration of hospital treatment in difficult clinical situations and in patients whose general condition is often severely compromised.

Abdominal hernia repair with bridging acellular dermal matrix--an expensive hernia sac

BACKGROUND

The ability of biologic mesh to remodel into native fascia and prevent hernia recurrence in complicated repairs is appealing. However, few long-term data exist evaluating these products in the setting of bridging fascial defects. These collagen-based mesh products are costly, and long-term evaluation of hernia recurrence rates are necessary to justify their expense.

METHODS

This was a retrospective review of patients undergoing repair of complex abdominal defects with acellular dermal matrix (ADM) at our institution was performed.

RESULTS

Between January 2004 and December 2005, 11 patients underwent complex ventral hernia repairs with bridging ADM. Indications for repair included resection of enterocutaneous fistula, infected mesh, and/or ventral hernia repair. A mean of 175 cm(2) (range 8 to 456) of ADM were used. Mean follow-up was 24 months (range 18 to 37). One patient died on postoperative day 20. Eight of the 10 (80%) remaining patients had recurrences, and 7 underwent further surgery for repair. One patient reported laxity but refused repair. The total cost of ADM alone for these 11 patients was $61,926; the cost for the 8 patients having recurrences was $40,776; and the total mean cost was $5,100/patient.

CONCLUSIONS

Although bridging fascial defects with ADM can be an appealing substitute in extremely complicated cases, our data demonstrate exceedingly high recurrence rates. The long-term outcome of bridging fascial defects with biologic prosthesis does not justify the expense of the product.

Abdominal compartment syndrome: a concise clinical review

OBJECTIVE

There has been an increased awareness of the presence and clinical importance of abdominal compartment syndrome. It is now appreciated that elevations of abdominal pressure occur in a wide variety of critically ill patients. Full-blown abdominal compartment syndrome is a clinical syndrome characterized by progressive intra-abdominal organ dysfunction resulting from elevated intra-abdominal pressure. This review provides a current, clinically focused approach to the diagnosis and management of abdominal compartment syndrome, with a particular emphasis on intensive care.

METHODS

Source data were obtained from a PubMed search of the medical literature, with an emphasis on the time period after 2000. PubMed "related articles" search strategies were likewise employed frequently. Additional information was derived from the Web site of the World Society of the Abdominal Compartment Syndrome (http://www.wsacs.org).

SUMMARY AND CONCLUSIONS

The detrimental impact of elevated intra-abdominal pressure, progressing to abdominal compartment syndrome, is recognized in both surgical and medical intensive care units. The recent international abdominal compartment syndrome consensus conference has helped to define, characterize, and raise awareness of abdominal compartment syndrome. Because of the frequency of this condition, routine measurement of intra-abdominal pressure should be performed in high-risk patients in the intensive care unit. Evidence-based interventions can be used to minimize the risk of developing elevated intra-abdominal pressure and to aggressively treat intra-abdominal hypertension when identified. Surgical decompression remains the gold standard for rapid, definitive treatment of fully developed abdominal compartment syndrome, but nonsurgical measures can often effectively affect lesser degrees of intra-abdominal hypertension and abdominal compartment syndrome.

Continuous retention suture for the management of open abdomen: a high rate of delayed fascial closure

BACKGROUND AND AIMS

Open abdomen is most often a consequence of damage control surgery, abdominal decompression or intra-abdominal infections. Ventral hernia after unsuccessful closure of open abdomen causes marked disability to the patient. Several methods for delayed fascial closure have been developed. Patients treated with continuous retention suture were evaluated to find out how often fascial closure was achieved, and what complications were related to the technique.

METHOD

A retrospective analysis of 16 open abdomen patients treated with continuous retention suture.

RESULTS

The most common cause of open abdomen was abdominal infection. Complete fascial closure was achieved in nine of the eleven surviving patients. Closure failed in one patient. Partial closure was also achieved in one patient. The median time between leaving the abdomen open and starting the process of closure was twelve days. The longest period of open abdomen before successful fascial closure was 29 days. Five patients died before the process of closure was complete.

CONCLUSION

Delayed fascial closure can be accomplished by using the retention suture method described here.

In Vitro Comparison of Intra-Abdominal Hypertension Development After Different Temporary Abdominal Closure Techniques

BACKGROUND

To compare volume reserve capacity (VRC) and development of intra-abdominal hypertension after different in vitro temporary abdominal closure (TAC) techniques.

METHODS

A model of the abdomen was designed. The abdominal wall was simulated with polychloroprene, a synthetic rubber compound. A lentil-shaped defect of 150 cm(2) was cut into the anterior aspect of the abdominal wall. TAC of this defect was performed by a zipper system (ZS), a bag silo closure (BSC), or a vacuum assisted closure (VAC) with subatmospheric pressures ranging from 0- to 200 mmHg. The model with intact abdominal wall served as reference. The model was filled with water to baseline level. The intra-abdominal pressure was increased in 2 mmHg steps from baseline level (6 mmHg) to 40 mmHg by adding volume to the system according to a standardized protocol. VRC with corresponding intra-abdominal pressure were analyzed and compared for the different TAC techniques.

RESULTS

VRC was the highest after BSC at all pressure levels studied (P < 0.05). VAC and ZS resulted in significantly lower VRC compared with BSC and reference (P < 0.05). The magnitude of negative pressure on the VAC did not significantly influence the VRC.

CONCLUSIONS

In the present in vitro model, BSC demonstrated the highest VRC of all evaluated TAC techniques. Different levels of subatmospheric pressures applied to the VAC did not affect VRC. The results for ZS and VAC indicate that these TAC techniques may increase the risk for recurrent intra-abdominal hypertension and should therefore not be used in high-risk patients during the initial phase after abdominal decompression.

Damage control surgery in the abdomen: An approach for the management of severe injured patients

Damage control is well established as a potentially life-saving procedure in a few selected critically injured patients. In these patients the 'lethal triad' of hypothermia, acidosis, and coagulopathy is presented as a vicious cycle that often can not be interrupted and which marks the limit of the patient's ability to cope with the physiological consequences of injury. The principles of damage control have led to improved survival and to stopped bleeding until the physiologic derangement has been restored and the patient could undergo a prolong operation for definitive repair. Although morbidity is remaining high, it is acceptable if it comes in exchange for improved survival. There are five critical decision-making stages of damage control: I, patient selection and decision to perform damage control; II, operation and intraoperative reassessment of laparotomy; III, resuscitation in the intensive care unit; IV, definitive procedures after returning to the operating room; and V, abdominal wall reconstruction. The purpose of this article is to review the physiology of the components of the 'lethal triad', the indication and principles of abdominal damage control of trauma patients, the reoperation time, and the pathophysiology of abdominal compartment syndrome.

Prospective evaluation of vacuum-assisted closure in abdominal compartment syndrome and severe abdominal sepsis

BACKGROUND

Open abdomen treatment because of severe abdominal sepsis and abdominal compartment syndrome remains a difficult task. Different surgical techniques are available and are often used according to the surgeon's personal experience. Recently, the abdominal vacuum-assisted closure (VAC) system has been introduced, providing a new possibility to treat an open abdomen. In this study, we evaluate the role of this treatment option.

STUDY DESIGN

This prospective observational cohort study includes 37 consecutive patients who were temporarily treated with VAC for severe abdominal sepsis or abdominal compartment syndrome, or both. Patients with abdominal trauma were excluded from the study. Thirty-seven patients undergoing major elective laparotomy and primary abdominal closure served as control group. Primary end points were fascial closure rate, physicoemotional recovery, and appearance outcomes 1 year after closure. Secondary end points included mortality, duration of open abdomen, length of ICU stay, and hospitalization time.

RESULTS

Abdomens were left open for 23 days (range 3 to 122 days) with 3.8 dressing changes (range 1 to 22) per patient. Abdominal closure was achieved in 70% (n = 26), with no marked relation to duration of open abdomen treatment (p > 0.05). After 3 months, patients with VAC treatment recovered to a physical and mental health status similar to patients in the control group (p > 0.05). This status remained stable until the end of the study. Aesthetic outcomes (according to the Vancouver Scar Scale) were considerably poorer in the VAC group compared with controls (p < 0.01).

CONCLUSIONS

Treatment of laparostomy with VAC for abdominal sepsis and abdominal compartment syndrome results in a high rate of successful abdominal closure. In addition, patients recover more rapidly, although hypertrophic scars might interfere with body perception. We recommend abdominal VAC system as first option if open abdomen treatment is indicated.

Cobertura temporária da cavidade abdominal com curativo a vácuo

OBJETIVO: Descrever técnica de curativo para cobertura temporária da cavidade abdominal que utiliza sistema de vácuo. MÉTODO: A técnica foi aplicada em 12 pacientes. Inicialmente coloca-se sobre a laparostomia a bolsa plástica fenestrada, em seguida a primeira camada de compressas. Sobre esta, coloca-se o tubo de látex. Este é recoberto por outra camada de compressas as quais são fixadas sobre o curativo com o campo cirúrgico auto-aderente. O tubo de látex é conectado ao sistema de vácuo com pressão de -10 a -50 mmHg. Trocam-se os curativos a cada 12 horas. Material utilizado bolsa plástica de solução salina, compressas cirúrgicas, tubo de látex, campo cirúrgico auto-aderente de 50cm x 30cm e vácuo do sistema de gases hospitalares. RESULTADOS:A peritonite grave foi a indicação mais freqüente para laparostomia, seguida da síndrome de compartimento abdominal. Fechamento definitivo da cavidade abdominal foi possível em oito pacientes (67%) em média após 11 dias (9 a 21 dias) da laparostomia. Não houve complicações associadas ao método. O custo diário aproximado do curativo foi de R$ 50,00. CONCLUSÃO: O curativo a vácuo proporcionou boa contenção das vísceras abdominais, controlou o extravasamento de secreções e o edema. Permitiu o fechamento definitivo da cavidade abdominal na maioria dos casos e foi de baixo custo.

Experience with vacuum-pack temporary abdominal wound closure in 258 trauma and general and vascular surgical patients

BACKGROUND

Temporary closure of an open abdominal wound by vacuum-pack is the method of choice for patients requiring open abdomen management in our institution. We have previously reported our experience with a vacuum-pack in trauma patients and have expanded its use to general and vascular surgery patients.

STUDY DESIGN

This is a descriptive study performed through review of medical records of all patients undergoing vacuum-pack closure after celiotomy from January 1999 to May 2006. Clinical and demographic data were collected.

RESULTS

Seven hundred seventeen vacuum-pack closures were performed in 258 surgical patients (116 trauma versus 142 general and vascular surgery). The most common indication for open abdomen management was damage control in trauma patients and planned reexploration in general and vascular surgery patients. Total abdominal complication rate was 15.5% (14.7% trauma versus 16.2% general and vascular surgery). Fistulas occurred in 13 (5%), intraabdominal abscesses in 9 (3.5%), bowel obstruction in 3 (1.2%), abdominal compartment syndrome in 3 (1.2%), and evisceration in 1 (0.4%). Two hundred twenty-six patients survived to permanent abdominal wound closure. Of these, 154 (68.1%) patients underwent primary fascial closure of their abdominal wounds. Seventy-two patients (31.9%) required delayed closure. In-hospital mortality rate was 26.0% (25.9% trauma versus 26.1% general and vascular surgery). The cost of vacuum-pack materials is less than $50.

CONCLUSIONS

Indication for open abdomen management varied between general and vascular surgery and trauma patients. Complication rates were similar. Primary closure of open abdominal wounds was achieved in 68.4% of patients. Vacuum-pack temporary abdominal wound closure, initially used in trauma patients, continues to demonstrate ease of mastery, effectiveness in patient care and comfort, consistently low associated complication rate, and low cost in both general and vascular surgery and trauma patients.