[Abdominal vacuum therapy for the open abdomen - a retrospective analysis of 82 consecutive patients]. / Intraabdominelle Vakuumtherapie des offenen Abdomens - Eine retrospektive Analyse von 82 konsekutiven Patienten.

BACKGROUND: The therapy for open abdomen remains challenging. Abdominal vacuum therapy seems to simplify the treatment and to enable a direct fascial closure in a high percentage of the patients. PATIENTS AND METHODS: A retrospective analysis of 82 consecutive patients who underwent abdominal vacuum therapy between January 2005 and December 2007 was undertaken. Indications, -duration of treatment, complications as well as rate and type of abdominal wall closure were evaluated. RESULTS: The 82 consecutive patients consisted of 46 % female and 54 % male patients with a median age of 65.5 years. The most frequent diagnoses were colorectal carcinoma (24 %, n = 28, colon n = 18 and rectum n = 10), inflammatory bowel dis-ease (13 %), perforated peptic ulcer (9 %), necrotising pancreatitis (7 %), peritoneal carcinosis (5 %), ileus (5 %) and mesenteric ischaemia (4 %). The predominant indication for vacuum therapy was peritonitis (88 %). Vacuum therapy treatment was applied for a median of 6 days (range: 1-73 days). 18 patients (22 %) received intraabdominal foam dressings without the fenestrated polyurethane layer. In 70 % of all cases the abdominal vacuum therapy was performed without complications. 16 patients (19.5 %) developed intestinal fistulas. However, fistulas were not observed among the patients who were treated with foam dressings without a polyurethane layer. Abdominal bleeding was observed in 8 patients (10 %) and a persistent abdominal compartment syndrome was seen in one patient. Nine patients (11 %) died during hospitalisation. After completion of the intraabdominal vacuum therapy, -direct fascial closure was feasible in 35 patients (43 %). In 47 patients (57 %) an absorbable synthetic mesh was required for fascial closure. Symptomatic incisional hernias -occurred in 22 % of the patients. CONCLUSION: Abdominal vacuum therapy simplifies the treatment of patients with abdominal catastrophes such as peritonitis or necrotising pancreatitis. The cost-effective intraperitoneal use of a foam dressing without a fenestrated polyurethane layer was possible without an increased rate of fistulas. This retrospective analysis demonstrates that abdominal vacuum therapy can be performed without complications in the majority of patients. Furthermore, direct fascial closure is possible in almost half of the patients.

[Peristomal dermatitis: a common condition and a differential diagnostic challenge]. / Ulkus, Infektion, Allergie, Ekzem. Hautprobleme rund ums Stoma.

Inflammation of the skin in the immediate neighborhood of a stoma (peristomal dermatitis) occurs--at least temporarily--in about two-thirds of all stoma patients. The often apparently uniform clinical presentation may conceal a variety of different pathological conditions, a knowledge of which is a must for the correct diagnosis and therapeutic strategy, which in turn is essential to prevent the development of a vicious circle of dermatitis and stomal insufficiency, which in the worst case may make a surgical intervention necessary.

Traumatic rupture of the descending thoracic aorta.

Timing and tactics in the repair of the traumatic ruptured thoracic aorta are matter of controversy ever since. The unmeasurable risk of a consecutive rupture favours a primary repair, concomitant injuries, however, a delayed repair. In single injuries of the thoracic aorta the clamp/repair procedure within 24 hours generates acceptable results with an overall mortality of 4 to 8% and a risk of ischemic myelopathy of 8 to 10%. Delayed repair reduces these figures not at all. Extracorporal circulation produces rather worse results in contrast to clamp/repair procedures. In cases of severe concomitant injuries, e.g. brain damage, hemorrhage and open fractures a delayed repair after cardiopulmonary reconstitution is required. In cases with posttraumatic pulmonary insufficiency the risk of surgical procedure itself is much higher than the risk of a second rupture of the traumatized thoracic aorta. We demonstrate our tactics in the repair of traumatic rupture of the descending aorta displaying clinical operated 1992/93.

Management of descending aortic dissection.

The optimal timing of surgery with Stanford type B aortic dissection remains controversal. In acute-phase cases, surgical mortality is so high that medical treatment is preferable unless there are major complications. To guide the choice of medical versus surgical therapy we use survival analysis in patients with acute uncomplicated/complicated and chronic uncomplicated/complicated descending aortic dissection. Between 1992 and 1993 49 patients were diagnosed with Stanford type B aortic dissection. Emergent surgery was performed in 4 patients for rupture or impending rupture, elective surgery was done in 12 patients. The remaining 33 patients were treated medically. Our results support the continued use of medical management as the primary treatment for uncomplicated acute aortic dissection, with surgical therapy being reserved for those patients with complications such as rupture, expansion, continuing pain or ischemia of distal vascular beds.

[Traumatic segment III aneurysm of the thoracic aorta: surgical risk, technique, early and late results]. / Traumatische Aneurysmen der thorakalen Aorta im Abschnitt III: Operationsrisiko, Technik, Früh- und Spätergebnisse.

Aneurysmectomy was performed in 37 patients with a traumatic aneurysm the aorta in segment III. 34 "cross-clamping" without bypass was used, 6 after preliminary transposition of the subclavian artery. 3 patients died after surgery, two of whom were more than 70 years old. 2 patients developed a paraparesis, which has in the meantime considerably improved. Hesitation to operate is justified only in older asymtomatic patients at high cardiac risk. Cross-clamping is preferable to more elaborate procedures. Preliminary transposition of the subclavian artery simplifies the proximal anastomosis and may contribute to spinal-cord protection.