Wittmann Patch Abdominal Closure

Since the late 1980\'s the concept of damage control laparotomy has emerged as a mainstay in the armamentarium of the trauma surgeon. In order to avoid the letha triad of hypothermia, coagulopathy, and metabolic acidosis; operations have been abruptly terminated after control of hemorrhage. Methods for temporary abdominal closure have subsequently evolved. This temporary abdominal closure technique employs a Velcro like material that is sutured to the fascia of the abdominal wall. This method allows for reexploration of the abdomen as well as slow re-approximation of the abdominal wall over a period of days. This makes if possible to perform a delayed primary closure of the fascia.

Trauma patients that once may have gone on to develop ventral hernieas with other temporary closure modalities are now able to be closed primarily.

T he infected abdomen poses substantial challenges to surgeons, and often, both temporary and definitive closure techniques are required. Temporary abdominal closure (TAC) allows surgeons ease of re-entry for multiple operations in an infected surgical field. Additionally, temporary closure helps reduce the risk of abdominal compartment syndrome (intra-abdominal hypertension) and its associated morbidity and mortality. Definitive reconstruction can be accomplished eventually in most cases through one of a variety of operative techniques.

We review the multiple options available to close the abdominal wall defect satisfactorily during and after the management of complicated intra-abdominal infections. Intra-abdominal infection carries a substantial risk of death, depending largely on the intensity of the patient\'s systemic response and the extent of the physiologic response, often measured by the Acute Physiology and Chronic Health Evaluation (APACHE) II score. The APACHE II score is a well-established and validated method by which to stratify risk in patients with intra-abdominal infections [,]. The goals of clinical management of intra-abdominal infections include control of bacterial or toxin sources, maintaining organ system function, and quelling the resultant inflammatory process [].

Occasionally, multiple laparotomies are required to eradicate intra-abdominal bacterial sources. This approach should be undertaken only when definitive closure of the abdomen is not possible initially. Performing re-laparotomy on demand, compared with planned re-laparotomy, yields a higher rate of anastomotic leakage, lower incisional hernias, and all surgery-related complications (intra-abdominal abscess, fistula, hemorrhage, perforation) []. In a sense, leaving the abdomen open in peritonitis is similar to the damage control approach for trauma. Leaving the abdomen open not only enables multiple operations but also helps prevent abdominal compartment syndrome. Perioperative fluid resuscitation of the patient leads frequently to visceral and retroperitoneal edema, ischemic fascia, and abdominal compartment syndrome. An intra-abdominal pressure >30 cm H 2O can result in decreased venous return and cardiac collapse, leading to multiple organ dysfunction syndrome, especially of the pulmonary, cardiovascular, renal, splanchnic, and central nervous systems (CNS).

Temporary abdominal closure with a bridged biologic mesh or synthetic system (e.g., Wittmann Patch, Bogota bag, vacuum-assisted closure [VAC device], synthetic mesh) between the fascial edges can help prevent abdominal compartment syndrome while preserving the fascial for eventual closure. In the setting of known compartment syndrome and intra-abdominal infection, VAC device, the Wittmann Patch, or a synthetic mesh allow flexibility in bedside adjustment as needed. Each system is described with and without the use of negative pressure devices (). Wittmann Patch The Wittmann Patch (STARSURGICAL, Inc., Burlington, WI) was designed to allow adjustment in the laxity or redundancy of the closure material to accommodate changes in intra-abdominal pressure and prevent abdominal compartment syndrome.

The Wittmann Patch (Starsurgical, Burlington, WI) is a unique device which uses velcro to permit progressive abdominal closure without necessitating serial.

Since the late 1980\'s the concept of damage control laparotomy has emerged as a mainstay in the armamentarium of the trauma surgeon. In order to avoid the letha triad of hypothermia, coagulopathy, and metabolic acidosis; operations have been abruptly terminated after control of hemorrhage. Methods for temporary abdominal closure have subsequently evolved. This temporary abdominal closure technique employs a Velcro like material that is sutured to the fascia of the abdominal wall. This method allows for reexploration of the abdomen as well as slow re-approximation of the abdominal wall over a period of days. This makes if possible to perform a delayed primary closure of the fascia.

Trauma patients that once may have gone on to develop ventral hernieas with other temporary closure modalities are now able to be closed primarily.

T he infected abdomen poses substantial challenges to surgeons, and often, both temporary and definitive closure techniques are required. Temporary abdominal closure (TAC) allows surgeons ease of re-entry for multiple operations in an infected surgical field. Additionally, temporary closure helps reduce the risk of abdominal compartment syndrome (intra-abdominal hypertension) and its associated morbidity and mortality. Definitive reconstruction can be accomplished eventually in most cases through one of a variety of operative techniques.

We review the multiple options available to close the abdominal wall defect satisfactorily during and after the management of complicated intra-abdominal infections. Intra-abdominal infection carries a substantial risk of death, depending largely on the intensity of the patient\'s systemic response and the extent of the physiologic response, often measured by the Acute Physiology and Chronic Health Evaluation (APACHE) II score. The APACHE II score is a well-established and validated method by which to stratify risk in patients with intra-abdominal infections [,]. The goals of clinical management of intra-abdominal infections include control of bacterial or toxin sources, maintaining organ system function, and quelling the resultant inflammatory process [].

Occasionally, multiple laparotomies are required to eradicate intra-abdominal bacterial sources. This approach should be undertaken only when definitive closure of the abdomen is not possible initially. Performing re-laparotomy on demand, compared with planned re-laparotomy, yields a higher rate of anastomotic leakage, lower incisional hernias, and all surgery-related complications (intra-abdominal abscess, fistula, hemorrhage, perforation) []. In a sense, leaving the abdomen open in peritonitis is similar to the damage control approach for trauma. Leaving the abdomen open not only enables multiple operations but also helps prevent abdominal compartment syndrome. Perioperative fluid resuscitation of the patient leads frequently to visceral and retroperitoneal edema, ischemic fascia, and abdominal compartment syndrome. An intra-abdominal pressure >30 cm H 2O can result in decreased venous return and cardiac collapse, leading to multiple organ dysfunction syndrome, especially of the pulmonary, cardiovascular, renal, splanchnic, and central nervous systems (CNS).

Temporary abdominal closure with a bridged biologic mesh or synthetic system (e.g., Wittmann Patch, Bogota bag, vacuum-assisted closure [VAC device], synthetic mesh) between the fascial edges can help prevent abdominal compartment syndrome while preserving the fascial for eventual closure. In the setting of known compartment syndrome and intra-abdominal infection, VAC device, the Wittmann Patch, or a synthetic mesh allow flexibility in bedside adjustment as needed. Each system is described with and without the use of negative pressure devices (). Wittmann Patch The Wittmann Patch (STARSURGICAL, Inc., Burlington, WI) was designed to allow adjustment in the laxity or redundancy of the closure material to accommodate changes in intra-abdominal pressure and prevent abdominal compartment syndrome.

The Wittmann Patch (Starsurgical, Burlington, WI) is a unique device which uses velcro to permit progressive abdominal closure without necessitating serial.