Managing the open abdomen with Vacuum-assisted closure therapy: retrospective evaluation of 22 patients

Background: The authors reviewed their experience in the management of "open abdomen" using the vacuum-assisted closure device (VAC (R)), in order to assess its morbidity particularly in terms of fistula, and the outcome of abdominal wall integrity. Methods: Between January 2003 and October 2006, 22 patients required management with an "open abdomen" technique (18 patients were managed with the VAC, abdominal dressing device with application of a specific sheet and 4 other patients simply required a dressing with the polyurethane sponge). The mean age was 55 years, and M/F sex ratio was 2.67. Indications were abdominal compartment syndrome in 7 patients, initial "abdominal closure" after trauma in one patient, severe abdominal sepsis in 7 patients, and abdominal wound dehiscence where closure was impossible in 7 patients. Results: There were no enteric fistulae. Two infections were seen - a chronic suppuration which resolved with antibiotic therapy and a deep abscess which was drained with radiologic guidance. Of the 18 cases of "open abdomen" managed with the VAC, 15 were alive. Six (40%) underwent a delayed primary closure at a mean interval of 9 days; the others underwent secondary healing by granulation, and 10 eventually underwent split thickness skin grafting at a mean interval of 50 days. With VAC closure of the "open abdomen", the development of ventral hernia is an anticipated outcome; in four cases, patients underwent abdominal wall reconstruction at an interval of one year. Conclusion: Laparostomy or "open abdomen" using the VACO dressing system should be considered an established and well-defined technique which provides temporary abdominal coverage with limited morbidity.