rAAA repair and abdominal compartment syndrome
Adding the Wittmann Patch® TAWT™ technique to the VAC regimen facilitated fascial closure and helped avoid a giant ventral hernia.
69 year old male (BMI 30) presented to the ED with back pain—rAAA and hemorrhagic shock. Taken to the OR for emergent endovascular repair.
| Day 1 | Abdomen opened for compartment syndrome secondary to massive volume resuscitation—dilated mesentery, bowel, and large retroperitoneal hematoma. |
| Day 3 | Washout and placement of Barker vacuum pack. |
| Day 4 | Large hematoma. Consideration of closure options, but poor operative candidate for big ventral hernia repair with separation of components. |
| Day 5 | Continuing diuresis. |
| Day 6 | Wound defect 18×29 cm. Placement of Wittmann Patch using TAWT technique and tightening with reduction of wound width to 9×29 cm. |
| Day 8 | Further tightening and wound reduction to 3×29 cm. |
| Day 11 | Wittmann Patch TAWT removal and fascial closure reinforced with a retrorectus Bio A. |
Case report courtesy of Nathan Schmoekel, DO, FACS.
