A selective vacuum assisted mesh mediated fascial traction approach following temporary abdominal containment for trauma laparotomy is effective in achieving closure

ABSTRACT

Background: Definitive primary abdominal closure is often not possible nor desirable following trauma laparotomy. In such situations, temporary abdominal containment (TAC) is necessary. This audit reviews our experience with TAC and interrogates our use of the Vacuum Assisted Mesh Mediated Fascial Traction approach (VAMMFT) to achieve delayed closure of the Open Abdomen (OA). Methods: We conducted a retrospective study over a 4-year period of trauma patients who underwent a trauma laparotomy and who required a TAC. Results: Over the four-year period, 596 patients underwent a laparotomy for trauma. Of these trauma laparotomies, 463 (78%) underwent primary closure and 133 (22%) required a TAC. Of these 133 patients who required a TAC, 37 died, 41 underwent delayed primary fascial closure at repeat laparotomy and 55 were left with an OA. Of this cohort of 55 patients, 15 underwent a VAMMFT procedure. The VAMMFT procedure yielded a 60% closure rate, with failure to close being due to late mesh insertion and sepsis. Conclusion: Our initial results with VAMMFT are encouraging. The technique appears to be effective and safe. Ongoing audit will allow us to accrue more patients and to better refine our algorithms and strategies