Vacuum-Assisted Wound Closure with Mesh-Mediated Fascial Traction Achieves Better Outcomes than Vacuum-Assisted Wound Closure Alone: A Comparative Study
- Authors: Salamone, G.; Licari, L.; Guercio, G.; Comelli, A.; Mangiapane, M.; Falco, N.; Tutino, R.; Bagarella, N.; Campanella, S.; Porrello, C.; Gullo, R.; Cocorullo, G.; Gulotta, G.
- Publication year: 2017
- Type: Articolo in rivista (Articolo in rivista)
- Key words: Abdomen; Abdominal Injuries; Adult; Aged; Fasciotomy; Female; Humans; Intra-Abdominal Hypertension; Male; Middle Aged; Negative-Pressure Wound Therapy; Peritonitis; Prospective Studies; Retrospective Studies; Sepsis; Traction; Treatment Outcome; Vacuum; Fascia; Surgical Mesh; Surgery
- OA Link: http://hdl.handle.net/10447/246073
Abstract
Background Open abdomen (OA) permits the application of damage control surgery principles when abdominal trauma, sepsis, severe acute peritonitis and abdominal compartmental syndrome (ACS) occur. Methods Non-traumatic patients treated with OA between January 2010 and December 2015 were identified in a prospective database, and the data collected were retrospectively reviewed. Patients’ records were collected from charts and the surgical and intensive care unit (ICU) registries. The Acosta ‘‘modified’’ technique was used to achieve fascial closure in vacuum-assisted wound closure and mesh-mediated fascial traction (VAWCM) patients. Sex, age, simplified acute physiology score II (SAPS II), abdominal compartmental syndrome (ACS), cardiovascular disease (CVD) and surgical technique performed were evaluated in a multivariate analysis for mortality and fascial closure prediction. Results Ninety-six patients with a median age of 69 (40–78) years were included in the study. Sixty-nine patients (72%) underwent VAWCM. Forty-one patients (68%) achieved primary fascia closure: two patients (5%) were treated with VAWC (37 median days) versus 39 patients (95%) who were treated with VAWCM (10 median days) (p = 0.0003). Forty-eight patients underwent OA treatment due to ACS, and 24 patients (50%) survived compared to 36 patients (75%) from the ‘‘other reasons’’ group (p = 0.01). The ACS group required longer mechanical ventilator support (p = 0.006), length of stay in hospital (p = 0.005) and in ICU (p = 0.04) and had higher SAPS II scores (p = 0.0002). Conclusions The survival rate was 62%. ACS (p = 0.01), SAPS II (p = 0.004), sex (p = 0.01), pre-existing CVD (p = 0.0007) and surgical technique (VAWC vs VAWCM) (p = 0.0009) were determined to be predictors of mortality. Primary fascial closure was obtained in 68% of cases. VAWCM was found to grant higher survival and primary fascial closure rate.