Changing negative pressure wound dressings in open abdomen - general and visceral surgery

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date of publication: 22.09.2008

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  • Inspection and adhesiolysis

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    22-51

    After removing the old NPWT dressing, prepping and sterile draping of the surgical field, inspect the abdomen and resolve any adhesions between the intestinal loops.

  • Lavage

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    22-61

    Extensive irrigation and lavage of the abdomen.

    Tip: Depending on local findings and underlying condition, respectively, the procedure may need to be extended.

  • Inserting the intra-abdominal component

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    Moisten the intra-abdominal component (perforated film with integrated sponge) of the NPWT system and insert it into the abdomen with moist dissecting sponges.

    Tip: Ensure that the film is inserted as deeply into the abdomen as possible and that it separates the abdominal wall from the bowel. Around the liver and the ligament or a stoma, the intra-abdominal film may need to be incised in order to insert it well deep into the abdomen without wrinkling.

  • Inserting the PU sponges

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    Insert the black polyurethane sponges such that they are level with the abdominal wall.

    Important: Care must be taken to ensure that the sponge is level with the abdominal wall and thus does not rest either under the fascia (risk of small bowel injury in the event of dislocation) or above the skin (risk of skin injury). Prevent excessive fascial retraction by sizing the black sponge smaller than the defect in the abdominal wall. The ready-made "breaks" facilitate correct sizing. Ensure not to trim the sponge above the abdomen, as this may allow small pieces to drop into the abdominal cavity.

  • Applying the film

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    Seal off the surgical field with self-adhesive film and in the film cut a hole of at least 2.5 cm directly above the black sponge.

    Important: The film must seal the entire abdomen airtight and ensure that the black sponge comes to rest directly at skin level.

    Tip: Application without wrinkles is facilitated by cutting the film into narrow strips.

  • Attaching the T.R.A.C.® system

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    Attach the T.R.A.C.® system to the hole previously made, connect the T.R.A.C.® system to the canister of the V.A.C.® (Vacuum assisted closure) pump and start treatment (continuous suction at -125 mmHg). At this point, the sponge can still be molded into the desired shape.