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Vacuum-Assisted Closure for Defects of the Abdominal Wall

DeFranzo, Anthony J. M.D.; Pitzer, Keith M.D.; Molnar, Joseph A. M.D., Ph.D.; Marks, Malcolm W. M.D.; Chang, Michael C. M.D.; Miller, Preston R. M.D.; Letton, Robert W. M.D.; Argenta, Louis C. M.D.

Plastic & Reconstructive Surgery: March 2008 - Volume 121 - Issue 3 - pp 832-839
doi: 10.1097/01.prs.0000299268.51008.47
Reconstructive: Trunk: Original Articles

Background: Reconstruction of the abdominal wall poses a problem common to many surgical specialties. Abdominal wall defects may be caused by trauma and/or prior surgery, with dehiscence or infection. Several options to repair the structural integrity of the abdominal wall exist, including primary closure, flaps, mesh, and skin grafts. Complications of these procedures include recurrent infection of the abdominal wall, infection of mesh, dehiscence, flap death, and poor skin graft take. Risk factors predisposing to these complications include tissue edema, preoperative tissue infection, and patient debilitation, with poor wound healing potential. Ideally, reconstruction should be performed on a nonedematous, clean tissue bed with bacterial levels less than 105 bacteria/cm3 in a well-nourished patient.

Methods: Vacuum-assisted closure was used in a series of patients in an attempt to prepare the abdominal wall for reconstruction and reduce the risk of complications. Charts were reviewed for 100 patients who underwent abdominal wall reconstruction after vacuum-assisted closure therapy. Their wound cause, reconstruction technique, complications, and number of days on the vacuum-assisted closure device are reported.

Results: The ability of vacuum-assisted closure to reduce edema, increase blood flow, potentially decrease bacterial colonization, and reduce wound size greatly facilitated abdominal wall reconstruction. The vacuum-assisted closure device served as a temporary dressing with which to control dehiscence and to maintain abdominal wall integrity when bowel wall edema prevented abdominal closure.

Conclusion: Vacuum-assisted closure therapy frequently shortened time to abdominal wall reconstruction and simplified the method of reconstruction.

Winston-Salem, N.C.

From the Departments of Plastic and Reconstructive Surgery and General Surgery, Wake Forest University School of Medicine.

Received for publication June 12, 2006; accepted November 28, 2006.

Presented in part at Plastic Surgery 2004: American Society of Plastic Surgeons Annual Meeting, in Philadelphia, Pennsylvania, October 9 through 13, 2004.

Disclosures: Wake Forest University School of Medicine receives royalties from the sale and use of the vacuum-assisted closure device and distributes a portion of the royalties to Louis C. Argenta, M.D., and Michael Morykwas, Ph.D. Joseph A. Molnar, M.D., Ph.D., receives research funds from Kinetic Concepts, Inc. (the manufacturer of the V.A.C.), and receives compensation for presentations at educational symposia sponsored by Kinetic Concepts, Inc. Joseph A. Molnar, M.D., Ph.D., receives research funds from Integra Life Sciences, Inc. (the manufacturer of Integra Dermal Regeneration Template), and receives compensation for presentations at educational symposia sponsored by Integra Life Sciences, Inc.

Anthony J. DeFranzo, M.D., Department of Plastic and Reconstructive Surgery, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, N.C. 27157-1075, adefranz@wfubmc.edu

©2008American Society of Plastic Surgeons