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.