Vacuum-Assisted Wound Closure Achieves Early Fascial Closure of Open Abdomens after Severe Trauma

TLDR

The study evaluates vacuum‑assisted wound closure for achieving primary fascial closure in severe trauma patients with open abdomens. The authors reviewed 35 shock‑resuscitated trauma patients treated with VAWC, changing dressings every 2–3 days and downsizing until fascial closure, using database and chart review for data. Among 35 patients, 86 % achieved fascial closure within an average of 7 days; 4 failures (2 fistulas) and no evisceration, abscess, or infection were observed, indicating a high success rate with acceptable complications.

Abstract

Background This study reviews the efficacy of vacuum-assisted wound closure (VAWC) to obtain primary fascial closure of open abdomens after severe trauma. Methods The study population included shock resuscitation patients who had open abdomens treated with VAWC. The VAWC dressing was changed at 2- to 3-day intervals and downsized as fascial closure was completed with interrupted suture. The Trauma Research Database and the medical records were reviewed for pertinent data. Results Over 26 months, 35 patients with open abdomens were managed by VAWC. Six died early, leaving 29 patients who were discharged. Of these, 25 (86%) were successfully closed using VAWC at a mean of 7 ± 1 days (range, 3–18 days). Of the four patients that failed VAWC, two developed fistulas. No patients developed evisceration, intra-abdominal abscess, or wound infection. Conclusion VAWC achieved early fascial closure in a high percentage of open abdomens, with an acceptable rate of complications.