Open Abdomens With Ongoing Intraabdominal Pathologies Successfully Closed Using A Dynamic Tissue System And Biologic Xenograft: A Case Series
Beatrice Caballero, Yana Puckett, Michelle Estrada, Shirley McReynolds, Robyn Richmond, Catherine Ronaghan.
Texas Tech University Health Sciences, Lubbock, TX, USA.
Background: Closure of catastrophic open abdomens after damage control laparotomy presents many challenges, particularly in the case of patients with complex pathologies that make achieving myofascial closure exceedingly difficult. The implantation of Porcine Urinary Bladder Matrix (PUBM) allowed for primary skin closure of contaminated wounds. This case series presents an alternative approach for definitive myofascial closure and accelerated wound healing in the setting of open abdomens with ongoing intraabdominal pathology. Methods:We present 5 patients managed with the ABRA Dynamic Tissue System (DTS) in combination with a PUBM xenograft. PUBM particulate is implanted directly on the myofascial closure. A PUBM 2-layer sheet is then placed subcutaneously utilizing a sutureless technique followed by definitive skin closure. Data was collected on the mechanism of injury, patient presentation, surgical management and patient outcomes via retrospective chart review. All 5 patients presented to our tertiary referral center with emergency general surgery issues or penetrating traumatic injuries. These patients had ongoing complex intraabdominal pathology, including a duodenal stump blowout, anastomotic failures (ileocolonic, colocolonic and hepaticojejunostomy/jejunojejunostomy) and a pancreaticoatmospheric fistula associated with multiple intraabdominal injuries sustained following an abdominal gunshot wound.Results: Average maximum myofascial gap was 22.8 cm (range: 11cm - 29cm). Average visceral extrusion was 9.2 cm (range: 4cm - 13cm). The DTS remained in place an average of 11.6 days (range: 8-14 days). Delayed primary myofascial closure was achieved in 5/5 patients (100%) with no fascial dehiscence or surgical site infections (SSIs) observed. Conclusion: In these heavily contaminated wounds, there were 0% SSIs after implantation of PUBM and primary skin closure. This technique essentially eliminated the need for negative pressure wound therapy (NPWT) postoperatively. We achieved 100% total wound healing which appears accelerated compared to historic controls. Utilization of DTS in conjunction with a xenograft combines both mechanical and biologic advantages in definitive closure and complete wound healing of the complex open abdomen.
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