Background
Treatment of open abdomen with negative pressure wound therapy (NPWT) in cases of abdominal sepsis and abdominal compartment syndrome results in a high rate of successful abdominal closure. The primary goals of wound management include avoidance of mechanical contamination of abdominal viscera, active removal of exudates, estimation of third space fluid loss, and infection control. NPWT involves application of topical negative pressure to the open wound. A non-adhesive perforated plastic barrier is placed over the viscera and extended laterally under the anterior abdominal wall. This first permeable layer is then covered with a polyurethane sponge and sealed with an airtight plastic sheet. An aspiration system is used to apply suction often ranging between 125 and 150 mmHg. The primary goal of this treatment is to remove contaminated fluid from the peritoneal cavity.
Temporary closure of the abdominal cavity with plastic bags, silicone sheets, absorbable and non-absorbable meshes sutured to the fascial or skin edges has not been found to facilitate permanent closure of the abdominal wall. Skin-only closure or split-thickness skin grafting may be used to cover the intestines and omentum. The major drawback of these techniques is the formation of extensive ventral hernias requiring later treatment. The use of airtight dressings and NPWT to manage the open abdomen has improved care and the potential for subsequent closure of the open abdomen. However, the method has occasionally been associated with increased development of intestinal and enteroatmospheric fistulae.
We have previously shown that NPWT induces ischemia in the small intestinal wall. We have also shown that placing a protective disc between the intestines and the vacuum source protects the intestines from ischemia. Persistent ischemia in the intestinal wall could explain why conventional NWPT has been associated with development of fistulae. In the present study, we examine the differences in pressure transduction in the open abdomen and fluid evacuation with conventional NPWT and NPWT with a protective disc between the intestines and the vacuum source. To our knowledge, no such study has previously been conducted.