AIM To compare the 3 main techniques of temporary closure of the abdominal cavity,vacuum assisted closure(vacuum-assisted closure therapy- VAC),Bogota bag and Barker technique,in damage control surgery.METHODS After s...AIM To compare the 3 main techniques of temporary closure of the abdominal cavity,vacuum assisted closure(vacuum-assisted closure therapy- VAC),Bogota bag and Barker technique,in damage control surgery.METHODS After systematic review of the literature,33 articles were selected to compare the efficiency of the three procedures.Criteria such as cost,infections,capacity of reconstruction of the abdominal wall,diseases associated with the technique,among others were analyzed.RESULTS The Bogota bag and Barker techniques present as advantage the availability of material and low cost,what is not observed in the VAC procedure.The VAC technique is the most efficient,not only because it reduces the tension on the boarders of the lesion,but also removes stagnant fluids and debris and acts at cellular level increasing cell proliferation and division.Bogota bag presents the higher rates of skin laceration and evisceration,greater need for a stent for draining fluids and wash-ups,higher rates of intestinal adhesion to the abdominal wall.The Barker technique presents lack of efficiency in closing the abdominal wall and difficulty on maintaining pressure on the dressing.The VAC dressing can generate irritation and dermatitis when the drape is applied,in addition to pain,infection and bleeding,as well as toxic shock syndrome,anaerobic sepsis and thrombosis.CONCLUSION The VAC technique,showed to be superior allowing a better control of liquid on the third space,avoiding complications such as fistula with small mortality,low infection rate,and easier capability on primary closure of the abdominal cavity.展开更多
Background: Septic open abdomens occur in trauma, burn and surgery. Currently, multiple concentrations of hypochlorous acid solutions have effectively decreased the microbiotic burden in wounds. We hypothesized that V...Background: Septic open abdomens occur in trauma, burn and surgery. Currently, multiple concentrations of hypochlorous acid solutions have effectively decreased the microbiotic burden in wounds. We hypothesized that Vashe?, a neutral hypochlorous acid solution (V-HOCL), would be safe as an intraperitoneal irrigation or washout disinfectant for septic open abdomens utilizing negative pressure wound therapy. Methods: This is a retrospective observational review of patients who required delayed abdominal closures after exploratory laparotomies. Group A (n = 8) had cyclical V-HOCL irrigation to their open abdomens combining AbtheraTM and V.A.C. Dressing System for negative pressure wound therapy with irrigation (NPWT-i) and Group B (n = 9) had intra-abdominal V-HOCL washouts. Results: Fifty percent of both groups had either septic or hemorrhagic shock on admission. Compared to Group B, Group A patients were older (median 50 vs 37 years), and had a median hospitalization of 28 vs 8 days, 4 times as many operations, more acute renal failure and co-morbidities. No statistically significant differences were detected be-tween the two treatment methods with the V-HOCL delivery and removal. Conclusion: There were no episodes of electrolyte imbalance, hypotension, hypertension, anaphylaxis, hemorrhage, visceral injury or systemic toxicity. V-HOCL with/without NPWT-i irrigation was a safe modality and tolerated well in this study.展开更多
The visceral protective layer is a standard component of the ABTHERA<sup>TM</sup> systems for temporary abdominal closures. Nonetheless, there are circumstances where the standard, fenestrated visceral pro...The visceral protective layer is a standard component of the ABTHERA<sup>TM</sup> systems for temporary abdominal closures. Nonetheless, there are circumstances where the standard, fenestrated visceral protective layer is too large to be successfully applied into every patient’s open abdomen, such as within the abdomen of a child, smaller adult or a patient with previously placed ostomies or drains. The fenestrated, visceral protective layer may require alterations or tailoring for adequate deployment instead of placing the bulk of the visceral protective layer entirely into the open abdomen for temporary abdominal closure. This case report illustrates how the visceral protective layer can be adapted or “reimagined” to conform to a patient with unique or complex abdominal domain features when utilizing the ABTHERA<sup>TM</sup> device prior to facial closure or abdominal wall reconstruction. Photographs are utilized in a step-by-step fashion to aid the clinician in these detailed maneuvers.展开更多
文摘AIM To compare the 3 main techniques of temporary closure of the abdominal cavity,vacuum assisted closure(vacuum-assisted closure therapy- VAC),Bogota bag and Barker technique,in damage control surgery.METHODS After systematic review of the literature,33 articles were selected to compare the efficiency of the three procedures.Criteria such as cost,infections,capacity of reconstruction of the abdominal wall,diseases associated with the technique,among others were analyzed.RESULTS The Bogota bag and Barker techniques present as advantage the availability of material and low cost,what is not observed in the VAC procedure.The VAC technique is the most efficient,not only because it reduces the tension on the boarders of the lesion,but also removes stagnant fluids and debris and acts at cellular level increasing cell proliferation and division.Bogota bag presents the higher rates of skin laceration and evisceration,greater need for a stent for draining fluids and wash-ups,higher rates of intestinal adhesion to the abdominal wall.The Barker technique presents lack of efficiency in closing the abdominal wall and difficulty on maintaining pressure on the dressing.The VAC dressing can generate irritation and dermatitis when the drape is applied,in addition to pain,infection and bleeding,as well as toxic shock syndrome,anaerobic sepsis and thrombosis.CONCLUSION The VAC technique,showed to be superior allowing a better control of liquid on the third space,avoiding complications such as fistula with small mortality,low infection rate,and easier capability on primary closure of the abdominal cavity.
文摘Background: Septic open abdomens occur in trauma, burn and surgery. Currently, multiple concentrations of hypochlorous acid solutions have effectively decreased the microbiotic burden in wounds. We hypothesized that Vashe?, a neutral hypochlorous acid solution (V-HOCL), would be safe as an intraperitoneal irrigation or washout disinfectant for septic open abdomens utilizing negative pressure wound therapy. Methods: This is a retrospective observational review of patients who required delayed abdominal closures after exploratory laparotomies. Group A (n = 8) had cyclical V-HOCL irrigation to their open abdomens combining AbtheraTM and V.A.C. Dressing System for negative pressure wound therapy with irrigation (NPWT-i) and Group B (n = 9) had intra-abdominal V-HOCL washouts. Results: Fifty percent of both groups had either septic or hemorrhagic shock on admission. Compared to Group B, Group A patients were older (median 50 vs 37 years), and had a median hospitalization of 28 vs 8 days, 4 times as many operations, more acute renal failure and co-morbidities. No statistically significant differences were detected be-tween the two treatment methods with the V-HOCL delivery and removal. Conclusion: There were no episodes of electrolyte imbalance, hypotension, hypertension, anaphylaxis, hemorrhage, visceral injury or systemic toxicity. V-HOCL with/without NPWT-i irrigation was a safe modality and tolerated well in this study.
文摘The visceral protective layer is a standard component of the ABTHERA<sup>TM</sup> systems for temporary abdominal closures. Nonetheless, there are circumstances where the standard, fenestrated visceral protective layer is too large to be successfully applied into every patient’s open abdomen, such as within the abdomen of a child, smaller adult or a patient with previously placed ostomies or drains. The fenestrated, visceral protective layer may require alterations or tailoring for adequate deployment instead of placing the bulk of the visceral protective layer entirely into the open abdomen for temporary abdominal closure. This case report illustrates how the visceral protective layer can be adapted or “reimagined” to conform to a patient with unique or complex abdominal domain features when utilizing the ABTHERA<sup>TM</sup> device prior to facial closure or abdominal wall reconstruction. Photographs are utilized in a step-by-step fashion to aid the clinician in these detailed maneuvers.
