Perioperative management - Change of an abdominal vacuum dressing in an open abdomen

Indications for the application of an abdominal vacuum dressing include all conditions where:

The abdomen cannot be closed, one does not want to close the abdomen, one or more abdominal revisions are planned, and/or one wants to preserve the fascia; for example, in cases of an incompletely or not securely sanitized infection focus or in staged lavage procedures.

Examples of visceral surgical conditions include, among others:

• Abdominal compartment syndrome (in the context of pancreatitis, but also trauma),
• Ileus
• Peritonitis

The application of the black sponge (polyurethane) on vessels or intestinal parts is prohibited, as it may lead to erosive bleeding or fistulas. In the presence of existing gastrointestinal fistulas, the applied suction should not exceed 75mmHg to prevent the fistula from being artificially kept open.

Preoperative diagnostics are based on the underlying disease and do not require expansion when planning the placement of an abdominal vacuum dressing.

Before applying the abdominal vacuum dressing, it must be ensured that a vacuum pump (where the level of suction can be adjusted (no Redon bottles!)), as well as appropriate sponges and connectors (T.R.A.C.® Pads), are available in the facility. The intra-abdominal component can be improvised with the help of a suction bag if necessary.

Due to the applied suction and the coarse-pored sponge, there may be erosions in vessels or the gastrointestinal tract with consequent fistulas. Additionally, the skin may macerate with direct sponge contact. The placement of an abdominal vacuum dressing obligatorily requires at least one more surgery (for closure).

• Intubation Anesthesia
• Laryngeal Mask Anesthesia

• Supine position
• Arms can be positioned outward

The surgeon stands on the right, the first assistant opposite. The scrub nurse stands at the foot end to the left of the assistant.

• special abdominal V.A.C.® system with sponge and film
• irrigation
• basic tray

Postoperative Analgesia: Dependent on the underlying disease.

Medical Follow-up Treatment: The postoperative follow-up treatment corresponds to the underlying disease. The application of an abdominal vacuum dressing obligatorily requires at least one more surgery (for closure).

Thrombosis Prophylaxis: Dependent on the underlying disease.

Mobilization: Patients can be mobilized (including standing and walking!!) and undergo physiotherapy with an abdominal vacuum dressing. This is one of the major advantages over the previous treatment with an open abdomen.

Physiotherapy/Dietary Build-up/Bowel Regulation/Incapacity for Work: Dependent on the underlying disease.