TAWT (Trans-Abdominal Wall Traction)
TAWT (pronounced "taut") is a technique to help close the acute open abdomen and reconstruct chronic giant ventral hernias. It avoids components separation and the need for bridging mesh while preserving 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 and StarGuard™ suture-retention plates to anchor sutures. The postulated mechanism is an isometric-traction-induced myofascial release that gradually lengthens the retracted oblique and latissimus muscles to recapture abdominal domain.
StarGuard™ 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.
To order StarGuard™ suture-retention plates, see the ordering instructions.
For additional information contact us.
TAWT Reapproximation and Closure with Wittmann Patch
Video: TAWT Surgical Technique with Wittmann Patch
“TAWT consistently recaptures lost domain, preserves the leading fascial edge, and eliminates the need for biologic bridges, components separation, or skin grafting.”
Dennis AJ et al: Not so fast to skin graft: Transabdominal wall traction closes most ‘‘domain loss’’ abdomens in the acute setting. J Trauma Acute Care Surgery, 2013: 74, (6) 1486-1492.
“Regardless of the cause of the giant ventral defect or the length of time it has existed, trans-abdominal wall traction can recapture abdominal domain and achieve midline fascial approximation and closure.”
Dennis AJ et al: Trans-Abdominal Wall Traction as a Universal Solution to the Management of Giant Ventral Hernias. Plastic and Reconstructive Surgery, 2015; 135: 4, 1113–1123.
Clinical reprints are available for the asking; please contact us for this or any other information.