The wittmann patch is a temporary abdominal closure device after decompressive celiotomy for abdominal compartment syndrome following burn. The patients were treated with decompressive celiotomy and wittmann patch closure. A wittmann patch consists of two opposing velcro sheets that are sutured to each fascial edge 11. Fascial closure immediately after definitive repair of injuries was defined as early fascial closure. Definitive abdominal closure was defined as coverage of abdominal viscera by either fascial closure or by splitthickness skin grafting stsg. The purpose of this study was to evaluate the impact of this device on our. In the absence of sepsis wittmann patch and vac offered the best outcome. The wittmann patch s a temporary abdominal closure device after decompressive celiotomy for abdominal compartment syndrome following. The wittmann patch can be used to perform a temporary abdominal closure tac or open abdomen oa as part of damage control surgical interventions in trauma, peritonitis or pancreatitis and generally in all those conditions at risk of intraabdominal pressure iap increase. The wittmann patch starsurgical, burlington, wi is a unique device which uses velcro to permit progressive abdominal closure without necessitating serial. Techniques for abdominal wall closure after damage control. Jun, 2017 the wittmann patch starsurgical inc, burlington, wi is a simple tool composed of two sheets 40. The use of the wittmann patch facilitates a high rate of fascial.
The opposing sheets are then fastened together in the midline. The wittmann patch is a temporary abdominal fascia. The following photos illustrate the wittmann patch application. Nao hiroe 1, shokei matsumoto 1, masayuki shimizu 1, tomohiro funabiki 1, motoyasu yamazaki 1. The wittmann patch helps prevent lateral retraction and maintain abdominal domain. If the surgeon places the patch without abdominal exploration, you should look instead to an appropriate integumentary system closure code for instance, 160, secondary closure of surgical wound or dehiscence, extensive or complicated, with modifier 58 appended. The wittmann patch is a velcro like device for bridging and reapproximating abdominal wall openings where primary closure is not possible andor repeat abdominal entries are necessary. Use of the wittmann patch, ideally before lateral retraction and loss of abdominal domain, can help achieve abdominal wall closure and avoid a planned ventral hernia. Opening and closure of the wittmann patch take only seconds. Jul 21, 2010 the wittmann patch starsurgical, burlington, wi, an artificial burr velcrolike device that is sutured to the abdominal fascia, when used to manage an open abdomen has been shown to facilitates dafc with a success rate 80% in a group of mixed trauma and abdominal sepsis patients. Since mid 2004, we have incorporated wittmann patch staged abdominal closure into our management of the open abdomen. Since april 2004, the wittmann patch was uniformly employed in open abdomen management. Jun, 2017 this closure enabled bedside inspection of the abdominal contents through a clear, biologically inert dressing when refractory ischemia or bleeding was a concern. A wittmann patch was used to close the abdominal wound.
A dodge that has twice helped me in a difficulty is the use of. The purpose of this study was to determine the fascial closure rate using the wittmann patch. Direct peritoneal resuscitation accelerates primary. Mar 30, 2005 if the surgeon places the patch without abdominal exploration, you should look instead to an appropriate integumentary system closure code for instance, 160, secondary closure of surgical wound or dehiscence, extensive or complicated, with modifier 58 appended. Twentysix patients underwent staged abdominal closure during the study period. Weinberg ja, george rl, griffin rl, stewart ah, reiff da, kerby jd, melton sm, rue lw iii.
Jun 01, 2017 wittmann patch staged abdominal closure jordan a. Like the predicate devices the wittmann patch is adjustable fascial expander prosthesis. Improved success with wittmann patch staged abdominal closure article in the journal of trauma 652. Billing for repeated openings of wittmann patch general. Accessgudid wittmann patch 00810805000187 for temporary bridging of abdominal wall openings where primary closure is not possible andor repeat abdominal entries are necessary. The two sheets adhere to each other when pressed together and provide a secure temporary closure of the abdominal wall. The wittmann patch is often used with open abdomen negative pressure treatment when negative pressure treatment alone isnt enough to achieve fasciatofascia closure. Other advantages of the wittmann patch technique include a gradual approximation of fascia, ease of reexploration, and prevention of loss of abdominal domain. Patients were reexplored when clinical parameters improved and the abdomen was closed, with.
The highest facial closure rates were seen with the wittmann patch 78%, dynamic retention sutures 71% and vac 61%. It is a device that consists of two adherent velcro sheets, one consisting of loops and the other of hooks. A case series of successful abdominal closure utilizing a. In some cases of abdominal trauma or infection, edema or packing precludes fascial closure after laparotomy. The management of catastrophic abdominal injuries has been described in past military conflicts. A bogota bag is a sterile plastic bag used for closure of abdominal wounds.
This closure enabled bedside inspection of the abdominal contents through a clear, biologically inert dressing when refractory ischemia or bleeding was a concern. Negative pressure wound therapy for the open abdomen. This makes if possible to perform a delayed primary closure of the fascia. Direct peritoneal resuscitation accelerates primary abdominal.
The wittmann patch is also added to negative pressure dressing systems when these systems alone are not enough to achieve fascial closure. Their cost is small in comparison with the substantial cost and morbidity associated with a second, planned abdominalwall. The wittmann patch starsurgical, burlington, wi is a unique device which uses velcro to permit progressive abdominal closure without necessitating serial operations. Closure of the difficult abdomen from the sages video library. The open abdomen oa is a planned management strategy implemented in critically injured patientsthatneed relaparotomy to complete definitive surgery. The use of the wittmann patch facilitates a high rate of. Examples of wittmann patch being used to treat and close abdominal wounds.
These include dynamic retention sutures drs, the wittmann patch, and the vacuum assisted wound closure vac system. All were initially managed with intravenous bag closure. Experience in the management of the open abdomen in severely. Weinberg ja, reiff da george rl, griffin rl, stewart ah, kerby jd, melton sm, rue lw iii closing the open abdomen. Some abdominal closure techniques allow for gradual reapproximation of the fascial edges and eventual primary closure 10. Temporary abdominal closure options include the wittmann patch, bogota bag, vacuumassisted closure vac, the abthera device, and synthetic or biologic mesh.
Experience in the management of the open abdomen in. Open abdomen in trauma and emergency general surgery. Therapy, and the abthera open abdomen negative pressure therapy system are inherently designed to effect not only a temporary closure but also a permanent fascial closure in most patients. This temporary abdominal closure technique employs a velcro like material that is sutured to the fascia of the abdominal wall. The open abdomen and temporary abdominal closure systems. The wittmann patch is a temporary abdominal fascia prosthesis for the planned open abdomen to ease management of cases where the abdomen cannot be closed due to abdominal compartment syndrome or because multiple further operations are planned damage control repair dcr. The submitted article entitled the wittmann patch as a temporary abdominal closure device after decompressive celiotomy for abdominal compartment syndrome following burn and its associated figures is an original manuscript which has not been previously published elsewhere and is not under consideration for publication by another editor. A case report of delayed fascial closure by wittmann patch after open abdomen management. Diagnosis of abdominal compartment syndrome was based on elevated bladder pressure and organ dysfunction. The wittmann patch is a temporary abdominal fascia prosthesis for the planned open abdomen to ease management of cases where the abdomen cannot be closed due to abdominal compartment syndrome or because multiple further operations are planned.
Negative pressure wound therapy for patients with complex. The wittmann patch also called artificial burr consists of two detachable components a loop sheet and a closure sheet typically the patch is sutured to the abdominal fascia and sequentially tightened every 24 48 hrs until fascia is 24cm apart this method is used in cases where primary closure cannot be. The wittmann patch as a temporary abdominal closure device. The wittmann patch for abdominal closure has been described in trauma literature as producing good results in comparison with previously used methods. Survivors subsequently underwent primary abdominal closure, with no evidence of ventral hernia at longterm followup.
He was associated with the following medical schools. While the vac system is automated, it does not supply sufficient closure force to quickly resolve large abdominal wounds. The wittmann patch consists of hookandloop velcrolike sheets that are pressed together to form a secure closure and peeled apart for abdominal re entry. Open abdomen treatment with dynamic sutures and topical negative pressure resulting in a high primary fascia closure rate. The open abdomen, indications, management and definitive closure. The methods of temporary abdominal closure included negative pressure wound therapy npwt, bogota bag, and wittmann patch starsurgical, burlington, wi.
Conclusion temporary abdominal closure has evolved from simple packing to vac based systems. Patients were re explored when clinical parameters improved and the abdomen was closed, with. The wittmann patch is a temporary abdominal fascia prosthesis for the planned open abdomen. Management of the open abdomen with the abdominal reapproximation anchor dynamic fascial closure system. One of the initial references of the use of open abdomen technique was by ogilvie in 1940 during world war ii. The authors considered that the wittmann patch provided a simple method to accommodate the change in abdominal girth and it has not been associated with spontaneous opening. Other techniques include the use of absorbable mesh, the wittmann patch, negative pressure wound therapy and dynamic closure systems. Although the open abdomen has likely contributed to improved outcomes in trauma patients, the challenge of subsequent fascial closure has emerged. The patch was used after celiotomy for our six burn cases with acs, but only two survived. The purpose of this study was to evaluate the impact of this device on our incidence of fascial closure versus planned ventral hernia. Plastic surgeons repair or replace skin tissue, bone, and other tissues.
Rumbolo is a plastic surgeon in saint louis, missouri. As swelling decreases, the fascial edges are gradually pulled together at dressing changes until able to close. The two sheets adhere to each other when pressed together and provide a secure temporary closure of the abdominal. Aug 12, 2015 the wittmann patch is a type of temporary abdominal closure that is used to incrementally close an open abdomen. These techniques are characterized by a tensionfree closure. On 4 separate occasions after that, he opened the patch, inspected the abdominal cavity, performed lavage, closed the patch and reapplied the wound vac 97605.
The wittmann patch consists of hookandloop velcrolike sheets that are pressed together to form a secure closure and peeled apart for abdominal reentry. Jul 25, 2015 the indications for open abdomen oa are generally all those situations in which is ongoing the development an intra abdominal hypertension condition iah, in order to prevent the development of abdominal compartmental syndrome acs. We hypothesized that use of the patch would result in a high closure rate. Jul 06, 2018 accessgudid wittmann patch 00810805000187 for temporary bridging of abdominal wall openings where primary closure is not possible andor repeat abdominal entries are necessary. The wittmann patch is a type of temporary abdominal closure that is used to incrementally close an open abdomen. A couple of days later, he reopened the incision 49002 and placed a wittmann patch and a wound vac 97605.
Eightythree per cent 20 of 24 went on to delayed primary closure of the abdomen, with a mean time of. In 16 survivors who had the wittmann patch placed to facilitate abdominal closure, 15 patients 94% had their fascial closed after removal of the patch. Their cost is small in comparison with the substantial cost and morbidity associated with a second, planned abdominal wall. A case report of delayed fascial closure by wittmann patch. In fact all those involved in care of a critically ill patient should in the first instance think how to prevent iah and acs. Open abdomen and its management linkedin slideshare. The sheets are cut to the length of the incision and sewn to the fascia. The wittmann patch technique is more costly and requires suturing to the abdominal fascia, which may increase the risk of fascial trauma and necrosis, and future. With resolving bowel edema, the abdominal viscera slowly reduced back into the abdominal cavity and the bag was truncated and resecured with metal clips to maintain domain 12, 18, 19. Patients managed by open abdomen from 2001 through 2006 were identified from the trauma registry. The wittmann patch as a temporary abdominal closure. Dec 27, 2015 other advantages of the wittmann patch technique include a gradual approximation of fascia, ease of reexploration, and prevention of loss of abdominal domain. Continuation of the open abdomen beyond the definitive repair of injuries with subsequent fascial closure was defined as delayed fascial closure. The rate of primary closure for the wittmann patch ranges from 78 to 100%.
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