Management Of The Open Abdomen In Burn Patients Utilizing A Novel Technique Combining A Mechanical Closure System With A Biologic Xenograft
Beatrice Caballero, Yana Puckett, Anceslo Idicula, John Griswold, Sharmila Dissanaike, Catherine Ronaghan.
Texas Tech University Health Sciences, Lubbock, TX, USA.
BACKGROUND: While better resuscitation systems have reduced the incidence of open abdomen (OA) in major burn patients, there are still a few who require damage control laparotomy and OA for intestinal ischemia. In the context of severe metabolic derangement this poses a unique management challenge with high morbidity and mortality.
METHODS: We present 2 OA burn patients managed with the ABRA Dynamic Tissue System (DTS) in combination with a Porcine Urinary Bladder Matrix (PUBM) xenograft. Data was collected on the mechanism of injury, patient presentation, surgical management of the burns as well as the open abdomen, and patient outcomes via retrospective chart review.
RESULTS: One patient was a 54-year-old male sustaining 37% TBSA after propane gas explosion. He developed Ogilvie’s syndrome with cecal ischemia and perforation, requiring a resection with ileostomy and mucous fistula. After laparotomy he had a myofascial gap of 19 cm and visceral extrusion of 6 cm. We achieved primary myofascial closure after 21 days of ABRA installation. The second patient was a 68-year-old male with 42% TBSA following a natural gas explosion, requiring decompressive laparotomy for compartment syndrome. He had a myofascial gap of 21 cm with visceral extrusion of 8 cm and was primarily closed 12 days following ABRA installation.
CONCLUSION: We present the first reported experience of successful primary closure of the open abdomen in burn patients using a novel technique. Working around the burns to install the device, the management of fluid loss and fluid shift issues exacerbated by the burns, addressing multiple organ dysfunction/failure issues presented particularly unique challenges.
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