Initial Clinical Experience Using Next Generation Open Abdomen Negative Pressure Therapy

Background: Temporary abdominal closure (TAC) can be utilized in patients with open abdomen due to severe abdominal infection, trauma, and abdominal compartment syndrome when abdominal closure is not possible. This technique allows for repeated open abdomen surgery without multiple incisions, and reduction of intra-abdominal pressure and abdominal expansion. The commercially available TACs have included open abdomen negative pressure therapy (OA-NPT) that provides medial tension to draw wound edges together helping minimize fascial retraction and loss of domain. 

Purpose: Recently, a new next generation OA-NPT dressing† has been developed that collapses medially under negative pressure, drawing wound edges together. Initial clinical experience using the next generation OA-NPT in 4 cases is presented.

Methods: Three males and 1 female presented to the emergency department with abdominal pain. Patient comorbidities included cancer, hypertension, and Patau Syndrome. During patient evaluation, computed tomography scans were performed and when necessary, the patients were started on intravenous antibiotics. All patients underwent exploratory surgery, abdominal washout, and placement of the next generation OA-NPT. Additional OA surgeries were performed 24-hours post-operatively for another abdominal washout or for further repair procedures. After each OA surgery, the next generation OA-NPT was applied.

Results: After 12-22 days, all 4 patients underwent closure using native fascia and were discharged from the hospital. In our experience, the next generation OA-NPT dressing application was similar to standard OA-NPT dressing with the new foam dressing providing increased medial tension. No gastrointestinal complications related to the next generation OA-NPT developed, indicating a similar safety profile to standard OA-NPT.

Conclusions: Overall, the next generation OA-NPT was easy to apply and contracted medially in a more effective manner compared to our previous experience with standard OA-NPT in these 4 patients.