The image at left shows temporary closure of the abdomen in a patient with increased abdominal pressure and intra-abdominal Infection. The bowel and omentum are covered by the two adhering sheets of biocompatible polymeric material that comprise the Wittmann Patch. The patch has been adjusted to accommodate increased intra-abdominal pressure and to allow for sufficient abdominal decompression. A slight tension is maintained on the fascial edges to prevent fascial retraction. As swelling from inflammatory edema subsides, fascial edges were gradually re-approximated by drawing the two sheets closer together and cutting away excess material. Final fascia-to-fascia suture closure followed to close the abdominal cavity for good. Even the skin may be closed if there is sufficient granulation tissue between fascia and skin to prevent superficial wound infection. Skin closure is generally possible after 5 to 6 abdominal entries. Temporarily covering the exposed abdomen with skin grafts becomes obsolete. We saw eventual hernia formationon only when we had to deal with non-midline pararectal incisions.
- Neutralizes increased intra-abdominal pressure
- Prevents fascial retraction
- Allows stepwise re-approximation of fascial edges
- Permits final fascia-to-fascia closure
- Reduces the need for hernia repair
- Allows easy access to the abdomen for further surgical procedures
- Excessively increased intra-abdominal pressure
- Abdominal trauma
- Intra-abdominal infections
- Acute pancreatitis with and without infection
- Bowel ischemia
- Traumatic and non traumatic intra-abdominal hemorrhage
- Ruptured abdominal aortic aneurysms
- Abdominal organ transplantation to foster abdominal perfusion and treat complications
Historically, many of these conditions have been associated with high morbidity and mortality rates. Often a definitive closure of the abdomen is precluded, which necessitates the surgical creation of an "open abdomen". More often than not, huge hernias result that then require expensive reconstructive procedures, often resulting in a less than optimal outcome for the patient. Use of the Wittmann Patch can substantially improve outcomes in such cases.