An African Perspective: Temporary closure of the open abdomen

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An African Perspective Temporary closure of
the open abdomen

• Sebastian van As Pradeep Navsaria
• Child Accident Prevention Foundation of Southern
  Africa
• Trauma Unit
• Red Cross Childrens Hospital
• Groote Schuur Hospital

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Africa

• 1 Billion people
• 700 000 000 children

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South Africa

• 47 million people
• 20 million children
• 20 000 murders
• 80 000 trauma deaths

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Causes of non-natural death
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Indications (n55)(Total laparotomies 732)

• Intra abdominal sepsis 28 (51)
• Visceral oedema 10 (18)
• Abd Comp Syndrome 9 (16)
• Abdominal packing 6 (11)
• Abdominal wall defect 2 (4)

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Requirements for Temporary Abdominal Closure (TAC)

• Material biologically inert
• Inexpensive
• Simple and rapidly performed
• Allow easy re-entry
• Dressing change in the ward
• Definitive fascial closure rate
• Keep patient dry
• Quantitates fluid loss
• Qualitates fluid loss
• Prevents abdominal compartment syndrome
• Maintain sterility

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Options

• Skin only closure
• Towel clip
• Silastic sheet
• Bogota bag
• 3l GU irrigation bag
• Steridrape/x-ray cassette
• Zippers
• Slide fasteners
• Velcro

• Polypropylene (NAbsor.)
• Polyglycolic (Absorb.)
• Hydrogel
• Aquacel
• Ioban
• Alloderm
• Visceral pack
• Vac Pack
• Abdominal wound vac

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Options

• Towel clip closure
• Modified zipper polypropylene mesh

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Modified Sandwich-Vacuum pack

• 3 liter Genito-urinary irrigation bag
• Schein et al, BJS 1991
• Sandwich Technique
• Brock et al, J Trauma 2000
• Vacuum Pack

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Original Article
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Materials and Technique

• 3 liter urological irrigation bag
• 2 nasogastric tubes
• 1 large Opsite?
• Nylon 1 sutures
• Y - connector

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Modified sandwich vacuum pack

• 10 Easy Steps

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Open abdomen 1
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Placement of irrigation bag 2
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Sheath sutures 3
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Placement of nasogastric tubes 4
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Preparation of Opsite 5
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NGT passed through Opsite 6
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Drainage bag applied 7
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Drainage bag seal 8
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Y connector 9
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Completed sandwich-vacuum dressing 10
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Schematic illustration
Opsite adhesive drape
Nylon 1 approximating sheath
wall
abdominal
NGT
3 liter urological irrigation bag
Peritoneal cavity
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Wound closure post open abdomen?
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Management in Ward
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Sponge vacuum dressing i
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Sponge vacuum dressing ii
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End-result of vacuum dressing
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Final outcome
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Results Comparative Cost of Materials
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Conclusion

• Technique is simple and rapidly applied
• Cost-effective
• Effective means of containing abdominal wall
  contents
• Allows easy re-entry into peritoneal cavity
• Dressing change can be done at bedside
• Definitive fascial closure rate

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• Thank You!

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Review TAC GSH Trauma Unit

• BJS June 2003
• 5-year retrospective review
• Trauma patients

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