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ORIGINAL RESEARCH article

Front. Surg.
Sec. Visceral Surgery
Volume 11 - 2024 | doi: 10.3389/fsurg.2024.1449702

Evaluating a novel vertical traction device for early closure in open abdomen management: a consecutive case series

Provisionally accepted
Jonas Dohmen Jonas Dohmen 1*Daniel Weissinger Daniel Weissinger 1Anne-Sophie T. Peter Anne-Sophie T. Peter 1Alexios Theodorou Alexios Theodorou 2Jörg C. Kalff Jörg C. Kalff 1Burkhard Stoffels Burkhard Stoffels 3Philipp Lingohr Philipp Lingohr 1Martin von Websky Martin von Websky 4
  • 1 Department of Surgery, University of Bonn, Bonn, Germany
  • 2 Department of Surgery, Ippokrateio University Hospital Athens, Athens, Greece
  • 3 Department of General and Visceral Surgery, Trauma Surgery, Cellitinnen-Hospital Holy Spirit,, Cologne, Germany
  • 4 Department of General, Visceral and Transplantation Surgery, University Hospital RWTH Aachen, Aachen, Germany

The final, formatted version of the article will be published soon.

    In emergency surgery, managing abdominal sepsis and critically ill patients with imminent abdominal compartment syndrome (ACS) using an open abdomen (OA) approach has become standard practice for damage control. To prevent significant complications associated with OA therapy, such as abdominal infections, entero-atmospheric fistula (EAF), and abdominal wall hernia formation, early definitive fascial closure (DFC) is crucial. This study aims to assess the feasibility of a novel device designed to facilitate early fascial closure in patients with an open abdomen.Methods Between 2019 and 2020, nine patients undergoing open abdomen management were enrolled in this study. All patients were treated using vertical mesh-mediated fascial traction combined with a novel vertical traction device (VTD). Data from these cases were collected and retrospectively analyzed.In this study, all patients were treated with OA due to impending ACS. Three patients died before achieving DFC, while the remaining six patients successfully underwent DFC. The mean number of surgical procedures after OA was 3 ± 1, and the mean time to DFC was 9 ± 3 days. The use of the VTD in combination with negative pressure wound therapy (NPWT) resulted in a 76 % reduction in fascia-to-fascia distance until DFC was achieved. The application of the VTD did not affect ventilation parameters or the Simplified Acute Physiology Score II (SAPS II), but intra-abdominal pressure (IAP) was reduced from 31 ± 8 mmHg prior to OA to 8.5 ± 2 mmHg after applying the device. The primary complication associated with the device was skin irritation, with three patients developing skin blisters as the most severe manifestation.Overall, the novel VTD appears to be a safe and feasible option for managing OA cases. It may reduce complications associated with OA by promoting early definitive fascial closure.

    Keywords: open abdomen (OA), Abdominal compartment syndrome (ACS), Temporary abdominal closure (TAC), Definitive fascial closure (DFC), vertical traction device (VTD), Negative pressure wound therapy (NPWT)

    Received: 15 Jun 2024; Accepted: 30 Jul 2024.

    Copyright: © 2024 Dohmen, Weissinger, Peter, Theodorou, Kalff, Stoffels, Lingohr and von Websky. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Jonas Dohmen, Department of Surgery, University of Bonn, Bonn, Germany

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