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.

Photo of the procedure