Negative pressure wound therapy for the open abdomen

Negative pressure wound therapy (NPWT) for the open abdomen may be used to manage open abdominal wounds (laparostomy) in which the gut and other intraperitoneal organs are exposed. These patients can be divided into 3 groups:

(a) patients who have had surgery that did not involve the gastrointestinal tract, and in whom delayed primary closure is planned within about 1 week (for example, after 'damage-control' surgery for trauma or repair of a ruptured abdominal aneurysm)

(b) patients who have had gastrointestinal tract surgery for the management of abdominal sepsis associated with severe gastrointestinal disease (including anastomotic dehiscence, visceral perforation or inflammatory bowel disease) or severe pancreatitis

(c) patients who have had abdominal wound dehiscence.

Intestinal fistulae may occur in any of these groups, either before or after use of NPWT is considered.

Open abdomens may be managed in a number of different ways, including application of a 'Bogota bag', systems with a 'zipper' allowing lavage, or various types of dressings. NPWT is an alternative to these methods. All of these techniques may be used as a prelude to delayed primary closure of the abdomen (especially in group (a) above). Alternatively, split-thickness skin grafts, mesh repair, muscle flaps or a combination of these may be used to close the abdomen (referred to in some of the published evidence as fascial closure).