| Abstract: Aims: Due to ongoing sepsis and fluid requirements, a subset of patients require an open abdomen for a prolonged period. This study is to describe a unique method that has allowed successful primary fascial closure at >30 days.
Methods: A retrospective, descriptive study over one year.
Results: Three patients required management with a prolonged open abdomen who were able to undergo successful primary closure at greater than 30 days. All three experienced severe sepsis with ongoing fluid requirements that prevented earlier closure. The same technique for temporary abdominal closure was used. There were no episodes of recurrent ACS, bowel fistula, abscess, or hernia.
Discussion: Many patients with ACS can undergo abdominal closure within 7-10 days. Beyond this, many form granulation tissue then undergo skin grafting. This results in a giant hernia that requires re-operation. There are many accepted methods of achieving temporary coverage. A combination technique that allowed gradual closure of the abdomen wall without formation of adhesions of the bowel to the peritoneum or the closure device was used. Initially, all patients underwent decompressive laparotomy. Initial closure was attained with moist towel and iodoban drape. If open abdomen was still required at 48 hours, the closure was replaced. This consisted of a sterile X-ray cassette cover placed over the bowel, but under the peritoneum and extending to both para-colic gutters. A velcro patch (Whittman PatchTM) was secured to the fascia. The patch was closed in the ICU as patient status permitted. The cassette cover prevented adhesions to the anterior abdominal wall. No dissection was required to mobilize the abdominal wall. We believe this contributed to lack of fistula formation. Granulation tissue did form over the bowel. All patients were able to achieve primary fascial closure at >30 days.
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