Perioperative management - Changing negative pressure wound dressings in open abdomen - general and visceral surgery
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Negative pressure wound therapy is indicated for all conditions in which:
The abdomen cannot be closed; is left open on purpose; one or more abdominal revisions are planned; and/or the fascia is to be spared, e.g., in the case of an infectious focus that has not been completely or reliably resolved, or in the case of staged lavage.
Examples of abdominal surgical conditions include, but are not limited to:
- Abdominal compartment syndrome (in the setting of pancreatitis, but also trauma),
Application of the black sponge (polyurethane) to vessels or parts of the intestine is contraindicated, as this may result in arterial bleeding or fistula formation. In pre-existing gastrointestinal fistulas, the applied suction should not exceed 75mmHg to prevent the fistula from being kept open "artificially".
Preoperative diagnostic work-up
Preoperative diagnostic work-up is based on the underlying clinical condition and, if abdominal negative wound pressure therapy is planned, does not require additional surgery.
Before applying the abdominal NPWT dressing, make sure that a vacuum pump (with adjustable level of suction (no Redon bottles!)), as well as appropriate sponges and connectors (T.R.A.C.® pads) are available in the department/hospital. If necessary, the intra-abdominal component can be fabricated by the surgeon him-/self using a suction pouch.
The attached suction and the large-pored sponge may erode vessels or in the gastrointestinal tract may result in consecutive fistula formation. In addition, when in direct contact with the sponge, the skin may become macerated. The application of an abdominal NWPT dressing mandates at least one additional surgical procedure (for closure).
Operating room setup
Special instruments and fixation systems