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Dynamic closure techniques for treatment of an open abdomen : an update

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Abstract
Background: The open abdomen (OA) is an important approach for managing intra-abdominal catastrophes and continues to be the standard of care. Despite this, challenges remain as it is associated with a high incidence of complications and poor outcomes. The objective is to perform a systematic review on dynamic closure techniques for fascial closure during open abdomen management. Methods: An electronic database search was conducted involving 4 different databases (MEDLINE (PubMed), SCOPUS, WEB OF SCIENCE (WOS) and EMBASE). All studies that described dynamic closure techniques in OA patients were eligible for inclusion. Data collected were synthesized by each outcome of interest. Results: Thirteen studies were included in the final synthesis. Overall methodological quality was low with a high number of retrospective observational studies and low number of patients. All included studies are observational cohort studies. No studies reported on the use of either Wittmann patch, dynamic retention sutures or ABRA system. Two studies reported on the ABRA system in combination with Negative Pressure Wound Therapy (NPWT), while 9 reported on mesh-mediated fascial traction (MMFT) combined with NPWT. Other types of fascial traction, either by dynamic suture lines or by a self-made silastic tube system, and NPWT were reported in 2 studies. Overall closure rates are 93.2% for the ABRA system + NPWT versus 72.0% for the mesh-mediated fascial traction + NPWT. Conclusion: Careful selection and good management of OA patients will avoid prolonged treatment and facilitate early fascial closure. Future research should focus on comparison of different temporary dynamic closure techniques to evolve toward best treatment options, in terms of both fascial closure rates and long-term incisional hernia rates.
Keywords
MEDIATED FASCIAL TRACTION, TEMPORARY ABDOMINAL CLOSURE, ASSISTED WOUND, CLOSURE, DELAYED CLOSURE, VACUUM, MANAGEMENT, THERAPY, CLASSIFICATION, Open abdomen, Dynamic closure, Negative pressure wound therapy, Systematic review

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Please use this url to cite or link to this publication:

MLA
Poortmans, Natalie, and Frederik Berrevoet. “Dynamic Closure Techniques for Treatment of an Open Abdomen : An Update.” HERNIA, 2020.
APA
Poortmans, N., & Berrevoet, F. (2020). Dynamic closure techniques for treatment of an open abdomen : an update. HERNIA.
Chicago author-date
Poortmans, Natalie, and Frederik Berrevoet. 2020. “Dynamic Closure Techniques for Treatment of an Open Abdomen : An Update.” HERNIA.
Chicago author-date (all authors)
Poortmans, Natalie, and Frederik Berrevoet. 2020. “Dynamic Closure Techniques for Treatment of an Open Abdomen : An Update.” HERNIA.
Vancouver
1.
Poortmans N, Berrevoet F. Dynamic closure techniques for treatment of an open abdomen : an update. HERNIA. 2020;
IEEE
[1]
N. Poortmans and F. Berrevoet, “Dynamic closure techniques for treatment of an open abdomen : an update,” HERNIA, 2020.
@article{8650168,
  abstract     = {Background: The open abdomen (OA) is an important approach for managing intra-abdominal catastrophes and continues to be the standard of care. Despite this, challenges remain as it is associated with a high incidence of complications and poor outcomes. The objective is to perform a systematic review on dynamic closure techniques for fascial closure during open abdomen management.
Methods: An electronic database search was conducted involving 4 different databases (MEDLINE (PubMed), SCOPUS, WEB OF SCIENCE (WOS) and EMBASE). All studies that described dynamic closure techniques in OA patients were eligible for inclusion. Data collected were synthesized by each outcome of interest.
Results: Thirteen studies were included in the final synthesis. Overall methodological quality was low with a high number of retrospective observational studies and low number of patients. All included studies are observational cohort studies. No studies reported on the use of either Wittmann patch, dynamic retention sutures or ABRA system. Two studies reported on the ABRA system in combination with Negative Pressure Wound Therapy (NPWT), while 9 reported on mesh-mediated fascial traction (MMFT) combined with NPWT. Other types of fascial traction, either by dynamic suture lines or by a self-made silastic tube system, and NPWT were reported in 2 studies. Overall closure rates are 93.2% for the ABRA system + NPWT versus 72.0% for the mesh-mediated fascial traction + NPWT.
Conclusion: Careful selection and good management of OA patients will avoid prolonged treatment and facilitate early fascial closure. Future research should focus on comparison of different temporary dynamic closure techniques to evolve toward best treatment options, in terms of both fascial closure rates and long-term incisional hernia rates.},
  author       = {Poortmans, Natalie and Berrevoet, Frederik},
  issn         = {1265-4906},
  journal      = {HERNIA},
  keywords     = {MEDIATED FASCIAL TRACTION,TEMPORARY ABDOMINAL CLOSURE,ASSISTED WOUND,CLOSURE,DELAYED CLOSURE,VACUUM,MANAGEMENT,THERAPY,CLASSIFICATION,Open abdomen,Dynamic closure,Negative pressure wound therapy,Systematic review},
  language     = {eng},
  title        = {Dynamic closure techniques for treatment of an open abdomen : an update},
  url          = {http://dx.doi.org/10.1007/s10029-020-02130-9},
  year         = {2020},
}

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