Direct peritoneal resuscitation accelerates primary. The wittmann patch is a temporary abdominal fascia prosthesis for the planned open abdomen to ease management of cases where the abdomen cannot be closed due to abdominal compartment syndrome or because multiple further operations are planned damage control repair dcr. Billing for repeated openings of wittmann patch general. The wittmann patch is a velcro like device for bridging and reapproximating abdominal wall openings where primary closure is not possible andor repeat abdominal entries are necessary. A case report of delayed fascial closure by wittmann patch. Plastic surgeons repair or replace skin tissue, bone, and other tissues. The addition of adjunctive dpr to the damage control strategy shortens the interval to definitive fascial closure without affecting overall resuscitation volumes. While the vac system is automated, it does not supply sufficient closure force to quickly resolve large abdominal wounds.
Accessgudid wittmann patch 00810805000187 for temporary bridging of abdominal wall openings where primary closure is not possible andor repeat abdominal entries are necessary. The methods of temporary abdominal closure included negative pressure wound therapy npwt, bogota bag, and wittmann patch starsurgical, burlington, wi. Mar 30, 2005 if the surgeon places the patch without abdominal exploration, you should look instead to an appropriate integumentary system closure code for instance, 160, secondary closure of surgical wound or dehiscence, extensive or complicated, with modifier 58 appended. Their cost is small in comparison with the substantial cost and morbidity associated with a second, planned abdominalwall. Aug 12, 2015 the wittmann patch is a type of temporary abdominal closure that is used to incrementally close an open abdomen. The mesh, zippers, or wittmann patch permits rapid and safe reentry into the abdomen on reexploration, and if an additional laparotomy is necessary in the future, permit a rapid closure. For this reason, this method enjoys popularity and it results in good overall outcomes. Examples of wittmann patch being used to treat and close abdominal wounds. Patients were reexplored when clinical parameters improved and the abdomen was closed, with. The wittmann patch consists of hookandloop velcrolike sheets that are pressed together to form a secure closure and peeled apart for abdominal reentry. This temporary abdominal closure technique employs a velcro like material that is sutured to the fascia of the abdominal wall. Therapy, and the abthera open abdomen negative pressure therapy system are inherently designed to effect not only a temporary closure but also a permanent fascial closure in most patients. Open abdomen and its management linkedin slideshare.
Opening and closure of the wittmann patch take only seconds. The submitted article entitled the wittmann patch as a temporary abdominal closure device after decompressive celiotomy for abdominal compartment syndrome following burn and its associated figures is an original manuscript which has not been previously published elsewhere and is not under consideration for publication by another editor. Open abdomen treatment with dynamic sutures and topical negative pressure resulting in a high primary fascia closure rate. A bogota bag is a sterile plastic bag used for closure of abdominal wounds. Techniques for abdominal wall closure after damage control. Since mid 2004, we have incorporated wittmann patch staged abdominal closure into our management of the open abdomen.
Improved success with wittmann patch staged abdominal closure article in the journal of trauma 652. On 4 separate occasions after that, he opened the patch, inspected the abdominal cavity, performed lavage, closed the patch and reapplied the wound vac 97605. Jul 06, 2018 accessgudid wittmann patch 00810805000187 for temporary bridging of abdominal wall openings where primary closure is not possible andor repeat abdominal entries are necessary. The wittmann patch is often used with open abdomen negative pressure treatment when negative pressure treatment alone isnt enough to achieve fasciatofascia closure. The wittmann patch for abdominal closure has been described in trauma literature as producing good results in comparison with previously used methods. The wittmann patch as a temporary abdominal closure. With resolving bowel edema, the abdominal viscera slowly reduced back into the abdominal cavity and the bag was truncated and resecured with metal clips to maintain domain 12, 18, 19. Other techniques include the use of absorbable mesh, the wittmann patch, negative pressure wound therapy and dynamic closure systems. The management of catastrophic abdominal injuries has been described in past military conflicts. Rumbolo is a plastic surgeon in saint louis, missouri. Direct peritoneal resuscitation accelerates primary abdominal.
The following photos illustrate the wittmann patch application. The wittmann patch starsurgical, burlington, wi is a unique device which uses velcro to permit progressive abdominal closure without necessitating serial. Although the open abdomen has likely contributed to improved outcomes in trauma patients, the challenge of subsequent fascial closure has emerged. In the absence of sepsis wittmann patch and vac offered the best outcome. Weinberg ja, reiff da george rl, griffin rl, stewart ah, kerby jd, melton sm, rue lw iii closing the open abdomen. This giant ventral hernia may then be dealt with using various reconstructive techniques after a long.
A case series of successful abdominal closure utilizing a. A couple of days later, he reopened the incision 49002 and placed a wittmann patch and a wound vac 97605. A case report of delayed fascial closure by wittmann patch after open abdomen management. Temporary abdominal closure options include the wittmann patch, bogota bag, vacuumassisted closure vac, the abthera device, and synthetic or biologic mesh. Closure of the difficult abdomen from the sages video library. Delayed primary closure in damage control laparotomy. Their cost is small in comparison with the substantial cost and morbidity associated with a second, planned abdominal wall. The sheets are cut to the length of the incision and sewn to the fascia.
Twentysix patients underwent staged abdominal closure during the study period. The wittmann patch is a temporary abdominal fascia prosthesis for the planned open abdomen to ease management of cases where the abdomen cannot be closed due to abdominal compartment syndrome or because multiple further operations are planned. Other advantages of the wittmann patch technique include a gradual approximation of fascia, ease of reexploration, and prevention of loss of abdominal domain. The use of the wittmann patch facilitates a high rate of fascial. In some cases of abdominal trauma or infection, edema or packing precludes fascial closure after laparotomy. Management of the open abdomen with the abdominal reapproximation anchor dynamic fascial closure system. The wittmann patch is a type of temporary abdominal closure that is used to incrementally close an open abdomen.
The open abdomen oa is a planned management strategy implemented in critically injured patientsthatneed relaparotomy to complete definitive surgery. The purpose of this study was to evaluate the impact of this device on our incidence of fascial closure versus planned ventral hernia. Use of the wittmann patch, ideally before lateral retraction and loss of abdominal domain, can help achieve abdominal wall closure and avoid a planned ventral hernia. The authors considered that the wittmann patch provided a simple method to accommodate the change in abdominal girth and it has not been associated with spontaneous opening. Fascial closure immediately after definitive repair of injuries was defined as early fascial closure. Nao hiroe 1, shokei matsumoto 1, masayuki shimizu 1, tomohiro funabiki 1, motoyasu yamazaki 1. We hypothesized that use of the patch would result in a high closure rate.
The wittmann patch can be used to perform a temporary abdominal closure tac or open abdomen oa as part of damage control surgical interventions in trauma, peritonitis or pancreatitis and generally in all those conditions at risk of intraabdominal pressure iap increase. Patients managed by open abdomen from 2001 through 2006 were identified from the trauma registry. In 16 survivors who had the wittmann patch placed to facilitate abdominal closure, 15 patients 94% had their fascial closed after removal of the patch. This method allows for reexploration of the abdomen as well as slow reapproximation of the abdominal wall over a period of days. The wittmann patch technique is more costly and requires suturing to the abdominal fascia, which may increase the risk of fascial trauma and necrosis, and future. University of hamburg, germany, university of dusseldorf, germany, university of california san francisco medical school,usa, hahnemann medical school, philadelphia,usa, medical college of wisconsin milwaukee, usa. These techniques are characterized by a tensionfree closure. The bogota bag is used to postpone definite closure until the underlying cause of the elevated intra abdominal pressure can be resolved. The wittmann patch starsurgical, burlington, wi is a unique device which uses velcro to permit progressive abdominal closure without necessitating serial operations. Eightythree per cent 20 of 24 went on to delayed primary closure of the abdomen, with a mean time of. A wittmann patch was used to close the abdominal wound. Survivors subsequently underwent primary abdominal closure, with no evidence of ventral hernia at longterm followup.
This makes if possible to perform a delayed primary closure of the fascia. Conclusion temporary abdominal closure has evolved from simple packing to vac based systems. Patients were re explored when clinical parameters improved and the abdomen was closed, with. Jul 21, 2010 the wittmann patch starsurgical, burlington, wi, an artificial burr velcrolike device that is sutured to the abdominal fascia, when used to manage an open abdomen has been shown to facilitates dafc with a success rate 80% in a group of mixed trauma and abdominal sepsis patients. Continuation of the open abdomen beyond the definitive repair of injuries with subsequent fascial closure was defined as delayed fascial closure. Aggressive resuscitation combined with staged surgery in severely injured patients has increased the incidence of abdominal compartment syndrome acs leading to the development ofopen abdomen strategy oa. The two sheets adhere to each other when pressed together and provide a secure temporary closure of the abdominal. Experience in the management of the open abdomen in. Some abdominal closure techniques allow for gradual reapproximation of the fascial edges and eventual primary closure 10. Dec 27, 2015 other advantages of the wittmann patch technique include a gradual approximation of fascia, ease of reexploration, and prevention of loss of abdominal domain. As swelling decreases, the fascial edges are gradually pulled together at dressing changes until able to close. The wittmann patch as a temporary abdominal closure device.
A wittmann patch consists of two opposing velcro sheets that are sutured to each fascial edge 11. This closure enabled bedside inspection of the abdominal contents through a clear, biologically inert dressing when refractory ischemia or bleeding was a concern. All were initially managed with intravenous bag closure. Survivors subsequently underwent primary abdominal closure, with no evidence of. Jul 25, 2015 the indications for open abdomen oa are generally all those situations in which is ongoing the development an intra abdominal hypertension condition iah, in order to prevent the development of abdominal compartmental syndrome acs. The wittmann patch s a temporary abdominal closure device after decompressive celiotomy for abdominal compartment syndrome following. In fact all those involved in care of a critically ill patient should in the first instance think how to prevent iah and acs. The wittmann patch is a temporary abdominal closure device after decompressive celiotomy for abdominal compartment syndrome following burn. Experience in the management of the open abdomen in severely.
The open abdomen and temporary abdominal closure systems. The opposing sheets are then fastened together in the midline. The two sheets adhere to each other when pressed together and provide a secure temporary closure of the abdominal wall. A dodge that has twice helped me in a difficulty is the use of. Open abdomen in trauma and emergency general surgery. The wittmann patch also called artificial burr consists of two detachable components a loop sheet and a closure sheet typically the patch is sutured to the abdominal fascia and sequentially tightened every 24 48 hrs until fascia is 24cm apart this method is used in cases where primary closure cannot be. The rate of primary closure for the wittmann patch ranges from 78 to 100%. Jun 01, 2017 wittmann patch staged abdominal closure jordan a. The wittmann patch helps prevent lateral retraction and maintain abdominal domain.
Diagnosis of abdominal compartment syndrome was based on elevated bladder pressure and organ dysfunction. Since april 2004, the wittmann patch was uniformly employed in open abdomen management. The purpose of this study was to determine the fascial closure rate using the wittmann patch. Jun, 2017 this closure enabled bedside inspection of the abdominal contents through a clear, biologically inert dressing when refractory ischemia or bleeding was a concern.
The wittmann patch consists of hookandloop velcrolike sheets that are pressed together to form a secure closure and peeled apart for abdominal re entry. The highest facial closure rates were seen with the wittmann patch 78%, dynamic retention sutures 71% and vac 61%. Weinberg ja, george rl, griffin rl, stewart ah, reiff da, kerby jd, melton sm, rue lw iii. Jun, 2017 the wittmann patch starsurgical inc, burlington, wi is a simple tool composed of two sheets 40. The use of the wittmann patch facilitates a high rate of. Negative pressure wound therapy for the open abdomen. The patch was used after celiotomy for our six burn cases with acs, but only two survived. The wittmann patch is also added to negative pressure dressing systems when these systems alone are not enough to achieve fascial closure.
Definitive abdominal closure was defined as coverage of abdominal viscera by either fascial closure or by splitthickness skin grafting stsg. These include dynamic retention sutures drs, the wittmann patch, and the vacuum assisted wound closure vac system. The wittmann patch is a temporary abdominal fascia. It is a device that consists of two adherent velcro sheets, one consisting of loops and the other of hooks. If the surgeon places the patch without abdominal exploration, you should look instead to an appropriate integumentary system closure code for instance, 160, secondary closure of surgical wound or dehiscence, extensive or complicated, with modifier 58 appended. One of the initial references of the use of open abdomen technique was by ogilvie in 1940 during world war ii. The purpose of this study was to evaluate the impact of this device on our. Negative pressure wound therapy for patients with complex. The open abdomen, indications, management and definitive closure.
The wittmann patch is a temporary abdominal fascia prosthesis for the planned open abdomen. He was associated with the following medical schools. Like the predicate devices the wittmann patch is adjustable fascial expander prosthesis. Several temporary abdominal closure systems are available for openabdomen management, some using negative pressure vac and vacuum pack and others with no active aspiration bogota bag, wittmann patch, dynamic retention sutures, absorbable or nonabsorbable mesh or sheet. The patients were treated with decompressive celiotomy and wittmann patch closure.
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