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.
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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.
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.