Acute chronic open abdomen repair using TAWT™
This case involves a 36 year old male, s/p damage control laparotomy 3 years prior at an outside hospital. He presented to Cook County Hospital after being hit by a car while riding his bicycle. As a result of this second trauma the skin graft over his large ventral hernia cracked and ulcerated.
He was scheduled for a planned ventral hernia revision. It was explained to him that due to the large size of his ventral hernia he would likely be a candidate for a staged trans abdominal wall traction (TAWT) primary closure or a bridging mesh.
At surgery his defect size was 30 cm wide by 36 cm in length. To facilitate TAWT a hook-and-loop Wittmann Patch™ (WP) was placed as a temporary underlay with suture coursing through all tissue layers of the abdominal wall, including skin. Knots were tied over padded aluminum bolsters overlaying the lateral edge of the rectus sheath. A soft plastic barrier was placed beneath the WP between peritoneum and bowel with a negative pressure dressing over the WP.
Over a period of 12 days he was gradually stretched using TAWT. He returned to the OR every 72 hours for tightenings, was extubated between cases, and was eating a general diet on the floor. On post op day 12 the WP and bolsters were removed and the re-approximated fascial borders primarily closed. An underlay biosynthetic mesh was placed to reinforce the closure.
He recovered well and was discharged from the hospital at day 15. No components separation was performed or necessary. At 23 months post op he has no evidence of a hernia and continues to work as a laborer.
Trans abdominal wall traction applied with padded aluminum bolster (finger splints with pre-drilled holes).
A plastic barrier separating bowel from peritoneum is beneath the Wittmann Patch, which is beneath the foam negative pressure dressing.
5 months post repair, fascia repair intact, no evidence of a hernia. At 23 months the patient continues to work as a laborer.
Case report courtesy of
Andrew Dennis, D.O., FACOS
Department of Trauma, JHS Cook County Hospital