TAWT (pronounced "taut") is a technique to help close the acute open abdomen and reconstructing chronic giant ventral hernias. TAWT helps achieve abdominal wall closure without components separation or bridging mesh and preserves the leading edge of the fascial borders for final closure.
TAWT utilizes the Wittmann Patch hook-and-loop sheets to apply constant isometric traction to both sides of the abdominal wall. The postulated mechanism is an isometric-traction-induced myofascial release that gradually lengthens the retracted oblique and latissimus muscles to recapture abdominal domain.
Suture retention plates enable lateral external attachment of underlay hook and loop sheets to the peritoneal surface of the abdominal wall.
- Two skin-protecting plates are positioned on each side of the abdominal wound over the lateral edge of the rectus sheath.
- Hydrocolloid sheets beneath the bolster plates may help to provide additional skin protection.
- A visceral protective layer is placed between bowel and peritoneum beneath the hook and loop sheets.
- The underlay hook-and-loop sheets are secured with heavy braided suture coursing through all layers of the abdominal wall, including skin, with knots tied over the bolster plates.
- A negative pressure dressing is placed on top of the Wittmann Patch.
- Staged TAWT is applied with the hook-and-loop sheets to re-approximate the fascial borders.
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Wittmann Patch TAWT Reapproximation and Closure