Surgical Technique
The following photos illustrate the Wittmann Patch application as described in the use instructions and in the clinical literature by surgeons using it together with an adhesion preventing barrier.
The Wittmann Patch is also added to negative pressure dressing systems when these systems alone are not enough to achieve fascial closure. The Wittmann Patch helps prevent lateral retraction and maintain abdominal domain. As swelling decreases, the fascial edges are gradually pulled together at dressing changes until able to close.
Click on any image below to enlarge it.
Attaching Velcro®-like Wittmann Patch to fascial borders with a running non-absorbable suture.
Adhesion preventing barrier (sterile X-Ray cassette cover with fenestrations shown as in references (1)(2)(4)) tucked between bowel and peritoneum out to lateral gutters.
Adhesion preventing barrier in position under the abdominal wall, over the abdominal viscera, and into the deep lateral gutters of the abdominal cavity (1)(2).
Loop sheet tucked under the opposing fascia and overlapped with the hook sheet to form a secure closure.
Overlapping hook sheet trimmed and adjusted with a slight tension to help prevent lateral retraction and maintain abdominal domain.
Negative Pressure Dressing.
Drain placement between layers of gauze over Wittmann Patch.
Alternatively, see pictures below using negative pressure Abdominal V.A.C® system.
Placement of Steri-Drape.
Application of negative pressure to remove fluids.
Negative pressure dressing change using Abdominal V.A.C.® system. Adhesion barrier is beneath the Wittmann Patch and V.A.C. sponge dressing is on top.
V.A.C sponge on top of Wittmann Patch with adhesive skin drape and suction hooked to negative pressure unit.
As abdominal swelling decreases, the fascial edges are pulled closer together. The Wittmann patch is opened at least once every 24 to 36 hours for dressing changes, procedures, inspections, and reapproximations. When the two fascial edges are close enough, the remaining patch material is removed and the abdominal wall closed fascia-to-fascia.
Surgical pictures 1, 9, 10 courtesy of Mauricio Miglietta, D.O.
Surgical pictures 2-8, 11 courtesy of Richard Fantus, M.D.