Rumbolo is a plastic surgeon in saint louis, missouri. Jun 01, 2017 wittmann patch staged abdominal closure jordan a. A case report of delayed fascial closure by wittmann patch after open abdomen management. The authors considered that the wittmann patch provided a simple method to accommodate the change in abdominal girth and it has not been associated with spontaneous opening. The wittmann patch as a temporary abdominal closure device. Their cost is small in comparison with the substantial cost and morbidity associated with a second, planned abdominal wall. Definitive abdominal closure was defined as coverage of abdominal viscera by either fascial closure or by splitthickness skin grafting stsg. The wittmann patch is a temporary abdominal fascia prosthesis for the planned open abdomen to ease management of cases where the abdomen cannot be closed due to abdominal compartment syndrome or because multiple further operations are planned. Plastic surgeons repair or replace skin tissue, bone, and other tissues. The sheets are cut to the length of the incision and sewn to the fascia.
The wittmann patch consists of hookandloop velcrolike sheets that are pressed together to form a secure closure and peeled apart for abdominal reentry. The opposing sheets are then fastened together in the midline. Although the open abdomen has likely contributed to improved outcomes in trauma patients, the challenge of subsequent fascial closure has emerged. Examples of wittmann patch being used to treat and close abdominal wounds. The wittmann patch consists of hookandloop velcrolike sheets that are pressed together to form a secure closure and peeled apart for abdominal re entry. The wittmann patch is a type of temporary abdominal closure that is used to incrementally close an open abdomen. The wittmann patch helps prevent lateral retraction and maintain abdominal domain. Open abdomen and its management linkedin slideshare.
He was associated with the following medical schools. A dodge that has twice helped me in a difficulty is the use of. The wittmann patch technique is more costly and requires suturing to the abdominal fascia, which may increase the risk of fascial trauma and necrosis, and future. The wittmann patch is a temporary abdominal fascia prosthesis for the planned open abdomen to ease management of cases where the abdomen cannot be closed due to abdominal compartment syndrome or because multiple further operations are planned damage control repair dcr. Survivors subsequently underwent primary abdominal closure, with no evidence of ventral hernia at longterm followup. In fact all those involved in care of a critically ill patient should in the first instance think how to prevent iah and acs.
Negative pressure wound therapy for patients with complex. This closure enabled bedside inspection of the abdominal contents through a clear, biologically inert dressing when refractory ischemia or bleeding was a concern. Aggressive resuscitation combined with staged surgery in severely injured patients has increased the incidence of abdominal compartment syndrome acs leading to the development ofopen abdomen strategy oa. The wittmann patch is often used with open abdomen negative pressure treatment when negative pressure treatment alone isnt enough to achieve fasciatofascia closure. Diagnosis of abdominal compartment syndrome was based on elevated bladder pressure and organ dysfunction. With resolving bowel edema, the abdominal viscera slowly reduced back into the abdominal cavity and the bag was truncated and resecured with metal clips to maintain domain 12, 18, 19. A wittmann patch consists of two opposing velcro sheets that are sutured to each fascial edge 11.
Eightythree per cent 20 of 24 went on to delayed primary closure of the abdomen, with a mean time of. Conclusion temporary abdominal closure has evolved from simple packing to vac based systems. The rate of primary closure for the wittmann patch ranges from 78 to 100%. Their cost is small in comparison with the substantial cost and morbidity associated with a second, planned abdominalwall. The open abdomen, indications, management and definitive closure. For this reason, this method enjoys popularity and it results in good overall outcomes.
These include dynamic retention sutures drs, the wittmann patch, and the vacuum assisted wound closure vac system. The bogota bag is used to postpone definite closure until the underlying cause of the elevated intra abdominal pressure can be resolved. Jul 06, 2018 accessgudid wittmann patch 00810805000187 for temporary bridging of abdominal wall openings where primary closure is not possible andor repeat abdominal entries are necessary. A bogota bag is a sterile plastic bag used for closure of abdominal wounds. Therapy, and the abthera open abdomen negative pressure therapy system are inherently designed to effect not only a temporary closure but also a permanent fascial closure in most patients. The addition of adjunctive dpr to the damage control strategy shortens the interval to definitive fascial closure without affecting overall resuscitation volumes. The wittmann patch can be used to perform a temporary abdominal closure tac or open abdomen oa as part of damage control surgical interventions in trauma, peritonitis or pancreatitis and generally in all those conditions at risk of intraabdominal pressure iap increase. On 4 separate occasions after that, he opened the patch, inspected the abdominal cavity, performed lavage, closed the patch and reapplied the wound vac 97605. Since mid 2004, we have incorporated wittmann patch staged abdominal closure into our management of the open abdomen. Other techniques include the use of absorbable mesh, the wittmann patch, negative pressure wound therapy and dynamic closure systems. The highest facial closure rates were seen with the wittmann patch 78%, dynamic retention sutures 71% and vac 61%.
The wittmann patch is also added to negative pressure dressing systems when these systems alone are not enough to achieve fascial closure. Survivors subsequently underwent primary abdominal closure, with no evidence of. Fascial closure immediately after definitive repair of injuries was defined as early fascial closure. Jun, 2017 this closure enabled bedside inspection of the abdominal contents through a clear, biologically inert dressing when refractory ischemia or bleeding was a concern. The open abdomen and temporary abdominal closure systems. We hypothesized that use of the patch would result in a high closure rate. Twentysix patients underwent staged abdominal closure during the study period. While the vac system is automated, it does not supply sufficient closure force to quickly resolve large abdominal wounds.
Since april 2004, the wittmann patch was uniformly employed in open abdomen management. The purpose of this study was to evaluate the impact of this device on our incidence of fascial closure versus planned ventral hernia. Open abdomen treatment with dynamic sutures and topical negative pressure resulting in a high primary fascia closure rate. Like the predicate devices the wittmann patch is adjustable fascial expander prosthesis. The wittmann patch is a temporary abdominal fascia prosthesis for the planned open abdomen. University of hamburg, germany, university of dusseldorf, germany, university of california san francisco medical school,usa, hahnemann medical school, philadelphia,usa, medical college of wisconsin milwaukee, usa. The following photos illustrate the wittmann patch application. Temporary abdominal closure options include the wittmann patch, bogota bag, vacuumassisted closure vac, the abthera device, and synthetic or biologic mesh. Aug 12, 2015 the wittmann patch is a type of temporary abdominal closure that is used to incrementally close an open abdomen.
Dec 27, 2015 other advantages of the wittmann patch technique include a gradual approximation of fascia, ease of reexploration, and prevention of loss of abdominal domain. A couple of days later, he reopened the incision 49002 and placed a wittmann patch and a wound vac 97605. Other advantages of the wittmann patch technique include a gradual approximation of fascia, ease of reexploration, and prevention of loss of abdominal domain. The purpose of this study was to evaluate the impact of this device on our. Experience in the management of the open abdomen in severely. Delayed primary closure in damage control laparotomy. Opening and closure of the wittmann patch take only seconds. In the absence of sepsis wittmann patch and vac offered the best outcome.
Jun, 2017 the wittmann patch starsurgical inc, burlington, wi is a simple tool composed of two sheets 40. Jul 21, 2010 the wittmann patch starsurgical, burlington, wi, an artificial burr velcrolike device that is sutured to the abdominal fascia, when used to manage an open abdomen has been shown to facilitates dafc with a success rate 80% in a group of mixed trauma and abdominal sepsis patients. Nao hiroe 1, shokei matsumoto 1, masayuki shimizu 1, tomohiro funabiki 1, motoyasu yamazaki 1. If the surgeon places the patch without abdominal exploration, you should look instead to an appropriate integumentary system closure code for instance, 160, secondary closure of surgical wound or dehiscence, extensive or complicated, with modifier 58 appended. One of the initial references of the use of open abdomen technique was by ogilvie in 1940 during world war ii. This giant ventral hernia may then be dealt with using various reconstructive techniques after a long. Direct peritoneal resuscitation accelerates primary.
The wittmann patch is a temporary abdominal closure device after decompressive celiotomy for abdominal compartment syndrome following burn. The wittmann patch starsurgical, burlington, wi is a unique device which uses velcro to permit progressive abdominal closure without necessitating serial. Continuation of the open abdomen beyond the definitive repair of injuries with subsequent fascial closure was defined as delayed fascial closure. The purpose of this study was to determine the fascial closure rate using the wittmann patch. Some abdominal closure techniques allow for gradual reapproximation of the fascial edges and eventual primary closure 10. The wittmann patch as a temporary abdominal closure. Accessgudid wittmann patch 00810805000187 for temporary bridging of abdominal wall openings where primary closure is not possible andor repeat abdominal entries are necessary. It is a device that consists of two adherent velcro sheets, one consisting of loops and the other of hooks.
Experience in the management of the open abdomen in. The submitted article entitled the wittmann patch as a temporary abdominal closure device after decompressive celiotomy for abdominal compartment syndrome following burn and its associated figures is an original manuscript which has not been previously published elsewhere and is not under consideration for publication by another editor. Direct peritoneal resuscitation accelerates primary abdominal. Negative pressure wound therapy for the open abdomen. The patch was used after celiotomy for our six burn cases with acs, but only two survived. The mesh, zippers, or wittmann patch permits rapid and safe reentry into the abdomen on reexploration, and if an additional laparotomy is necessary in the future, permit a rapid closure. Improved success with wittmann patch staged abdominal closure article in the journal of trauma 652. The patients were treated with decompressive celiotomy and wittmann patch closure. The wittmann patch for abdominal closure has been described in trauma literature as producing good results in comparison with previously used methods.
Patients managed by open abdomen from 2001 through 2006 were identified from the trauma registry. The wittmann patch is a velcro like device for bridging and reapproximating abdominal wall openings where primary closure is not possible andor repeat abdominal entries are necessary. Mar 30, 2005 if the surgeon places the patch without abdominal exploration, you should look instead to an appropriate integumentary system closure code for instance, 160, secondary closure of surgical wound or dehiscence, extensive or complicated, with modifier 58 appended. The use of the wittmann patch facilitates a high rate of. The wittmann patch starsurgical, burlington, wi is a unique device which uses velcro to permit progressive abdominal closure without necessitating serial operations. A case report of delayed fascial closure by wittmann patch. Patients were reexplored when clinical parameters improved and the abdomen was closed, with. Weinberg ja, george rl, griffin rl, stewart ah, reiff da, kerby jd, melton sm, rue lw iii.
Several temporary abdominal closure systems are available for openabdomen management, some using negative pressure vac and vacuum pack and others with no active aspiration bogota bag, wittmann patch, dynamic retention sutures, absorbable or nonabsorbable mesh or sheet. The use of the wittmann patch facilitates a high rate of fascial. Use of the wittmann patch, ideally before lateral retraction and loss of abdominal domain, can help achieve abdominal wall closure and avoid a planned ventral hernia. The wittmann patch also called artificial burr consists of two detachable components a loop sheet and a closure sheet typically the patch is sutured to the abdominal fascia and sequentially tightened every 24 48 hrs until fascia is 24cm apart this method is used in cases where primary closure cannot be. The two sheets adhere to each other when pressed together and provide a secure temporary closure of the abdominal. Techniques for abdominal wall closure after damage control. The management of catastrophic abdominal injuries has been described in past military conflicts. The two sheets adhere to each other when pressed together and provide a secure temporary closure of the abdominal wall.
This method allows for reexploration of the abdomen as well as slow reapproximation of the abdominal wall over a period of days. The wittmann patch is a temporary abdominal fascia. Billing for repeated openings of wittmann patch general. As swelling decreases, the fascial edges are gradually pulled together at dressing changes until able to close. This makes if possible to perform a delayed primary closure of the fascia.
The methods of temporary abdominal closure included negative pressure wound therapy npwt, bogota bag, and wittmann patch starsurgical, burlington, wi. Open abdomen in trauma and emergency general surgery. Closure of the difficult abdomen from the sages video library. In 16 survivors who had the wittmann patch placed to facilitate abdominal closure, 15 patients 94% had their fascial closed after removal of the patch. These techniques are characterized by a tensionfree closure. Management of the open abdomen with the abdominal reapproximation anchor dynamic fascial closure system. A case series of successful abdominal closure utilizing a. Patients were re explored when clinical parameters improved and the abdomen was closed, with. Weinberg ja, reiff da george rl, griffin rl, stewart ah, kerby jd, melton sm, rue lw iii closing the open abdomen. Jul 25, 2015 the indications for open abdomen oa are generally all those situations in which is ongoing the development an intra abdominal hypertension condition iah, in order to prevent the development of abdominal compartmental syndrome acs. All were initially managed with intravenous bag closure. The wittmann patch s a temporary abdominal closure device after decompressive celiotomy for abdominal compartment syndrome following. This temporary abdominal closure technique employs a velcro like material that is sutured to the fascia of the abdominal wall.
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