Use of dynamic wound closure system in conjunction with vacuum-assisted closure therapy in delayed closure of open abdomen

AIM

Definitive abdominal closure may not be possible for several days or weeks after laparotomy in damage-control surgery, abdominal compartment syndrome and intraabdominal sepsis, until the patient has stabilized. Vacuum-assisted closure (VAC therapy(®), KCI, San Antonio, TX, USA) and abdominal re-approximation anchor system (ABRA, Canica, Almonte, Ontario, Canada) are novel techniques in delayed closure of open abdomen. Our aim is to present the use of these strategies in the management of 7 patients with open abdomen.

METHODS

Between August 2010 and December 2011, 7 patients with severe peritonitis were stabilized by laparotomy and treated with either ABRA system or ABRA system in conjunction with VAC dressing. VAC dressing applied to 4 patients initially and followed by ABRA. ABRA was applied alone to remaining 3 patients. Demographic data and patient characteristics, timing of VAC dressing and ABRA system were recorded. ICU and hospital stay and development of incisional hernia were also recorded. Stage of open abdomen, width of abdominal defect, extent to damage to fascia, and pressure sores were staged.

RESULTS

The mean duration with VAC dressing before ABRA application was 18 days. The mean duration of ABRA application was 53 days. The average width of the abdominal defect was 18 cm. The average length of defect was 20.8 cm. Delayed primary abdominal closure was accomplished in 6 patients without further surgery. Incisional hernia with a small abdominal defect developed in 2 patients.

CONCLUSION

Abdominal re-approximation anchor system and VAC dressing can be used separately or in conjunction with each other for closure of delayed open abdomen successfully.

Diallel analysis of four agronomic traits in common wheat

The common wheat cultivars Aköz, Florence, Mentana, Jaral, and Siete Cerros were crossed in 1972 in all possible combinations excluding reciprocals. In 1972--1973 the F1 hybrids and the five parents were field grown at Bornova in randomized complete blocks. The characters studied were plant height, spike length, 1000-kernel weight, and plant yield. The analysis of data showed that (a) with respect to plant height and 1000-kernel weight all F1 combinations deviated from the corresponding midparental values, (b) for the same characters the GCA variances were significant and the GCA divided by SCA ratios high, (c) the characters' plant height, spike length, and 1000-kernel weight were probably controlled by two effective factors each, and (d) plant height had the highest and 1000-kernel weight the lowest heritability (h2=0.66 and h2=0.26, respectively). It was concluded that a desired response to selection could be expected for plant height and 1000-kernel weight.