A proposed algorithm for managing the open abdomen. Export

@article{citeulike:2872521, abstract = {Delayed abdominal closure has gained acceptance in managing a variety of surgical conditions. Multiple techniques were devised to promote safe, uncomplicated, expeditious fascial closure. We retrospectively reviewed patient records between September 22, 2001 and June 30, 2004. Of the 20 patients with open abdomen, two patients died within 24 hours and one was transferred. The remaining 17 were managed using an algorithm including a combination of delayed primary closure (DPC), vacuum-assisted fascial closure (VAFC), Wittmann Patch (WP) (Star Surgical, Inc., Burlington, WI), and planned ventral hernia via absorbable mesh with split thickness skin grafting (PVH). The mean Simplified Acute Physiology Scores (SAPS II) was 31 (predicted mortality 73\%). All patients initially underwent VAFC and re-exploration 12-48 hours later. Indications for continued VAFC included 1) gross contamination, 2) massive bowel edema, 3) continued bleeding at re-exploration. If these conditions were absent, DPC was attempted or a WP was employed until fascial closure. Twenty-eight day mortality was 5.9 per cent (1/17 patients). Enterocutaneous fistulae occurred in two patients (11.7\%). Fascial closure was achieved in 6 patients (35.3\%). Eleven patients were managed with PVH. Using an algorithm with a combination of several techniques, open abdomen can be managed with minimal morbidity and acceptable closure rates.}, address = {Department of Surgery, St. Luke's Hospital and Health Network, Bethlehem, Pennsylvania 18015, USA.}, author = {Cipolla, J. and Stawicki, S. P. and Hoff, W. S. and McQuay, N. and Hoey, B. A. and Wainwright, G. and Grossman, M. D.}, citeulike-article-id = {2872521}, citeulike-linkout-0 = {http://view.ncbi.nlm.nih.gov/pubmed/15869132}, citeulike-linkout-1 = {http://www.hubmed.org/display.cgi?uids=15869132}, issn = {0003-1348}, journal = {The American surgeon}, keywords = {4, abdomen, abdominal, compartment, laparostomy, open, syndrome}, month = {March}, number = {3}, pages = {202--207}, posted-at = {2008-06-07 20:00:25}, priority = {2}, title = {A proposed algorithm for managing the open abdomen.}, url = {http://view.ncbi.nlm.nih.gov/pubmed/15869132}, volume = {71}, year = {2005} }

TY - JOUR ID - citeulike:2872521 L3 - citeulike-article-id:2872521 N2 - Delayed abdominal closure has gained acceptance in managing a variety of surgical conditions. Multiple techniques were devised to promote safe, uncomplicated, expeditious fascial closure. We retrospectively reviewed patient records between September 22, 2001 and June 30, 2004. Of the 20 patients with open abdomen, two patients died within 24 hours and one was transferred. The remaining 17 were managed using an algorithm including a combination of delayed primary closure (DPC), vacuum-assisted fascial closure (VAFC), Wittmann Patch (WP) (Star Surgical, Inc., Burlington, WI), and planned ventral hernia via absorbable mesh with split thickness skin grafting (PVH). The mean Simplified Acute Physiology Scores (SAPS II) was 31 (predicted mortality 73%). All patients initially underwent VAFC and re-exploration 12-48 hours later. Indications for continued VAFC included 1) gross contamination, 2) massive bowel edema, 3) continued bleeding at re-exploration. If these conditions were absent, DPC was attempted or a WP was employed until fascial closure. Twenty-eight day mortality was 5.9 per cent (1/17 patients). Enterocutaneous fistulae occurred in two patients (11.7%). Fascial closure was achieved in 6 patients (35.3%). Eleven patients were managed with PVH. Using an algorithm with a combination of several techniques, open abdomen can be managed with minimal morbidity and acceptable closure rates. IS - 3 JF - The American surgeon SN - 0003-1348 AD - Department of Surgery, St. Luke's Hospital and Health Network, Bethlehem, Pennsylvania 18015, USA. EP - 207 TI - A proposed algorithm for managing the open abdomen. VL - 71 SP - 202 KW - 4 KW - abdomen KW - abdominal KW - compartment KW - laparostomy KW - open KW - syndrome AU - Cipolla, J AU - Stawicki, SP AU - Hoff, WS AU - McQuay, N AU - Hoey, BA AU - Wainwright, G AU - Grossman, MD PY - 2005/03// UR - http://view.ncbi.nlm.nih.gov/pubmed/15869132 ER -