A case report of delayed fascial closure by Wittmann patch after open abdomen management

• Published in: Nihon Kyukyu Igakukai Zasshi 2011/11/15, Vol.22(11), pp.852-857
• Main Authors: Hiroe, Nao, Matsumoto, Shokei, Shimizu, Masayuki, Funabiki, Tomohiro, Yamazaki, Motoyasu, Kitano, Mitsuhide
• Format: Article
• Language: eng ; jpn
• Subjects: damage control surgery; definitive closure; IAP; temporary closure
• ISSN: 0915-924X; 1883-3772
• DOI: 10.3893/jjaam.22.852

Although open abdomen management (OAM) is sometimes necessary after emergency surgery for trauma or acute abdomen, abdominal closure is difficult during prolonged OAM. We report a case in which delayed primary closure was achieved using the Wittmann patch. A 58-year-old woman was taken to the hospital with hemodynamic instability after injury from a fall. Transarterial embolization was performed for pelvic fracture. Subsequently, the patient developed abdominal distension. Emergency laparotomy revealed a massive retroperitoneal hematoma. Because of intraoperative coagulopathy and hypothermia, gauze packing and vacuum pack closure (VPC) was performed. On postoperative day (POD) 2, because of oozing of blood and intestinal edema repacking and VPC was performed. On POD 3, the patient developed uncontrollable septic shock. We reopened the packing and found panperitonitis with pus on the omentum and small intestine despite the absence of perforation. Daily intraperitoneal lavage was performed. When the inflammation settled on POD 12, we sutured the Wittmann patch to each fascia and tightened it daily at the bedside. Both fascias reached the midline on POD 16, and we completed definitive closure. There was no evidence of complications at the 6-month follow-up. The Wittmann patch has the ability to complete delayed abdominal closure in prolonged OAM.