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Vacuum-assisted wound closure and mesh-mediated fascial traction for open abdomen therapy: a systematic review
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.ORCID iD: 0000-0001-6561-9734
2017 (English)In: Anaesthesiology intensive therapy, ISSN 1731-2515, Vol. 49, no 2, p. 139-145Article, review/survey (Refereed) Published
Abstract [en]

BACKGROUND: The aim of this paper was to review the literature on vacuum-assisted wound closure and mesh-mediated fascial traction (VAWCM) in open abdomen therapy. It was designed as systematic review of observational studies.

METHODS: A Pub Med, EMBASE and Cochrane search from 2007/01-2016/07 was performed combining the Medical Subject Headings "vacuum", "mesh-mediated fascial traction", "temporary abdominal closure", "delayed abdominal closure", "open abdomen", "abdominal compartment syndrome", "negative pressure wound therapy" or "vacuum assisted wound closure".

RESULTS: Eleven original studies were found including patients numbering from 7 to 111. Six studies were prospective and five were retrospective. Nine studies were on mixed surgical (n = 9), vascular (n = 6) and trauma (n = 6) patients, while two were exclusively on vascular patients. The primary fascial closure rate per protocol varied from 80-100%. The time to closure of the open abdomen varied between 9-32 days. The entero-atmospheric fistula rate varied from 0-10.0%. The in-hospital survival rate varied from 57-100%. In the largest prospective study, the incisional hernia rate among survivors at 63 months of median follow-up was 54% (27/50), and 16 (33%) repairs out of 48 incisional hernias were performed throughout the study period. The study patients reported lower short form health survey (SF-36) scores than the mean reference population, mainly dependent on the prevalence of major co-morbidities. There was no difference in SF-36 scores or a modified ventral hernia pain questionnaire (VHPQ) at 5 years of follow up between those with versus those without incisional hernias.

CONCLUSIONS: A high primary fascial closure rate can be achieved with the vacuum-assisted wound closure and meshmediated fascial traction technique in elderly, mainly non-trauma patients, in need of prolonged open abdomen therapy.

Place, publisher, year, edition, pages
2017. Vol. 49, no 2, p. 139-145
Keywords [en]
mesh-mediated fascial traction, negative pressure wound therapy, open abdomen, temporary abdominal closure, vacuum
National Category
Surgery
Identifiers
URN: urn:nbn:se:uu:diva-334973DOI: 10.5603/AIT.a2017.0023ISI: 000404441500009PubMedID: 28502075OAI: oai:DiVA.org:uu-334973DiVA, id: diva2:1161267
Available from: 2017-11-29 Created: 2017-11-29 Last updated: 2017-12-14Bibliographically approved

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