A. D. Jalilvand1, S. Srivatsa1, D. Eiferman1 1The Ohio State University, Trauma And Critical Care, Columbus, OH, USA
Objectives: Open abdomens (OA) not amenable to primary fascial closure (PFC) are often managed with placement of a bridging biologic mesh and have an increased risk of developing enterocutaneous fistulae (ECF). Direct peritoneal resuscitation (DPR) has been associated with reduced inflammation and complications in OA patients. Additionally, negative pressure wound therapy (NPWT) can stimulate tissue granulation by reducing edema and increasing vascularity. We designed a method to integrate the benefits of DPR and NPWT to decrease complications after placement of a bridging biologic mesh using a continuous irrigation NWPT system (3MTM VerafloTM). We hypothesized this method would lead to healthy granulation tissue without increased rate of ECF formation, while maintaining the integrity of the mesh during this process.
Methods: All OA patients who were not amenable to PFC were eligible for the intervention from 2021-2022. We placed an inlay biologic mesh with an overlying Vaseline-soaked gauze. Next, we assembled NPWT using a Hydrophilic (White Foam) Wound VAC sponge covered by VerafloTM foam and an occlusive dressing. Normal saline irrigation (20cc/5 minutes q8 hours) was instilled through the superior port and suctioned out the inferior port (100 mg Hg continuous pressure). The VAC was changed Monday/Thursday at bedside. Wound progression and outcomes were documented.
Results: Since 2021, eight patients underwent the intervention. Four patients died of their underlying disease process prior to wound closure. There were no immediate complications directly related to the NPWT with no device failures. All survivors (n=4) developed healthy granulation tissue and were suitable for skin grafting. Median time from initial mesh placement to wound healing following skin grafting was 96 days (range 92-160 days). No survivors developed an ECF. Figure 1 documents the progression of the wound from initial mesh and NPWT placement to post skin grafting.
Conclusion: Preliminary results suggest that continuous instillation using the VerafloTM system promoted healthy granulation tissue and was not associated with ECF development. Given the ease and reproducibility of this technique, further studies should be done to document the role of NPWT with instillation for OA patients where PFC is not possible.
