Vacuum-Assisted Fascial Closure in the Management of Open Abdomen. The Optimal Foam’s Position

Abstract Often surgeons face complex situations when leaving the abdomen open temporarily is the best and quickest option that save lives. In 1986, a novel therapy using negative pressure with marlex mesh cover by op-site wound dressing, called the “sandwich technique” was described by Schein. This case report significantly changed the management of open abdomen. Several trial were performed with different meshes (Polypropylene, Dexon, Gore-Tex, Polyethilene, Poliglactin) in combination with silicone bags, or not, with high mortality and high rate of massive hernias but promising results. On 90’s the term planned hernia was widely used. Miller in 2004 demonstrate that was possible vacuum-assisted fascial closure (VAFC) which enables late fascial closure in open abdomen patients up to a month after initial laparotomy by substituting the surgical towels with polyurethane sponge and attached a special drain and pump for liquid aspiration. Complication rates did not differ from patients with planned hernia, and the need for future abdominal wall reconstruction was avoided. Following this pre-packed dressing system was introduced. Some authors combined VAC with the Bogotá bag and others with mesh. The system was designed to actively manage the open abdomen by removing fluid and helping reduce visceral oedema. The system evolved to the advanced model when they fenestrated the foam increasing the medial traction, but can fascial traction be improved? The author presents in this video how the position of dressing can improve medial traction and closure.