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Episode 032 Requirements Of An Optimal Device For Temporary Abdominal Closure
Requirements Of An Optimal Device For Temporary Abdominal Closure
Temporary abdominal closure (TAC) has been demonstrated to be an effective method for the
prevention of intra-abdominal hypertension (IAH) and treatment of abdominal compartment
syndrome (ACS). A variety of TAC devices have been described including plastic silos (the
so-called ?Bogota bag?), prosthetic meshes, Velcro? burrs (the Wittmann? patch), the
home-made ?vacuum-pack? dressing, the KCI vacuum-assisted closure (V.A.C.?) Abdominal
Dressing, and the recently introduced ABThera? Open Abdomen Dressing. The optimal
requirements for a TAC device include: 1) abdominal content control, 2) active removal and
quantification of peritoneal fluid / exudate, 3) prevention of visceral adherence, 4) prevention
of fascial retraction, 5) infection control, 6) inflammatory response reduction, 7) enteric fistula
prevention / control, and 8) facilitation of functional abdominal closure. Each of the devices
listed above possesses a variable ability to modulate these characteristics.
TAC represents an important tool in what may be termed ?active total abdominal
management?, which emphasizes the goals of decreased intra-abdominal pressure, active
removal of pro-inflammatory cytokines, decreased organ dysfunction and failure, decreased
fistulization, and increased same-admission definitive abdominal closure. This comprehensive
open abdomen management strategy is associated with improved patient survival, reduced
length of stay, and increased definitive abdominal closure among patients who require an
open abdomen. Such a management strategy, however, must begin at the time of initial
decompression to fully realize these benefits.
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Requirements Of An Optimal Device For Temporary Abdominal Closure
Temporary abdominal closure (TAC) has been demonstrated to be an effective method for the
prevention of intra-abdominal hypertension (IAH) and treatment of abdominal compartment
syndrome (ACS). A variety of TAC devices have been described including plastic silos (the
so-called ?Bogota bag?), prosthetic meshes, Velcro? burrs (the Wittmann? patch), the
home-made ?vacuum-pack? dressing, the KCI vacuum-assisted closure (V.A.C.?) Abdominal
Dressing, and the recently introduced ABThera? Open Abdomen Dressing. The optimal
requirements for a TAC device include: 1) abdominal content control, 2) active removal and
quantification of peritoneal fluid / exudate, 3) prevention of visceral adherence, 4) prevention
of fascial retraction, 5) infection control, 6) inflammatory response reduction, 7) enteric fistula
prevention / control, and 8) facilitation of functional abdominal closure. Each of the devices
listed above possesses a variable ability to modulate these characteristics.
TAC represents an important tool in what may be termed ?active total abdominal
management?, which emphasizes the goals of decreased intra-abdominal pressure, active
removal of pro-inflammatory cytokines, decreased organ dysfunction and failure, decreased
fistulization, and increased same-admission definitive abdominal closure. This comprehensive
open abdomen management strategy is associated with improved patient survival, reduced
length of stay, and increased definitive abdominal closure among patients who require an
open abdomen. Such a management strategy, however, must begin at the time of initial
decompression to fully realize these benefits.