Negative pressure therapy in the treatement of suppurated eventrated laparotomic wound

Abstract

Introduction: The laparotomic suppurated eventrated wound is a postoperative complication caused by contamination, suppuration and necrosis of the abdominal wall anatomical layers (subcutaneous fat, ventral aponeurosis, peritoneum) with eventration of abdominal organs. The use of negative pressure therapy in the treatment of laparotomic suppurated eventrated wound is described worldwide in the specialty literature, but its efficiency depending on the etiology of the intraabdominal infection remains insufficiently studied. Purpose and Objectives: Reporting the results of the treatement with negative pressure of the patients with laparotomic suppurated eventrated wounds. Materials and Methods: From October 2012 until March 2014, negative pressure therapy was used in the treatement of laparotomic suppurated eventrated wounds in 22 patients with the mean age of 64.2 and sex ratio M:F being 15:7. The study included patients with laparotomic suppurated eventrated wounds due to diffuse peritonitis in the following nosologies: inguinal hernia with small bowel necrosis (1), postoperative ventral hernia (1), gastric adenocarcinoma with perforation (1), gangrenous cholecystic perforation (1), closed abdominal trauma with bowel (1) and small intestine injury (1), fistular Crohn's disease (1), gangrenous perforative appendicitis (3), colon ischemia and necrosis with perforation (2), nonspecific ulcerative colitis with intestinal obstruction (1), colon diverticulum perforation (2), benign tumor of the colon with mechanic obstruction (1), colon adenocarcinoma with mechanic obstruction (3), colon adenocarcinoma with perforation (3). Results: The negative pressure therapy set at 75-105 mmHg was applied after necrectomy, with a mean duration of the sessions o f 48-72 hours. The number of sessions was determined by the type of intraabdominal infection. Wound closure criteria were: the presence of mature granulation tissue, the type of inflammatory-regeneratory cytological imprints and the decrease of the amounts of wound microflora from 106"7 to 102_J. The treatment was carried out in two stages: the first stage - negative pressure therapy with suturing of the ventral aponeurosis, the second stage - continuing negative pressure therapy with complete closure of the laparotomic wound. Definitive closure of the abdominal w'all was possible in 19 patients. 3 patients died, the mortality rate constituting 13.6%. Conclusions: The use of negative pressure therapy in the treatment of the laparotomic suppurated eventrated wounds allows to: eliminate the septic source, decrease the frequency of dressings changes- one at 48-72 hours with a fascial closure rate of 86.4%.