الفهرس | Only 14 pages are availabe for public view |
Abstract The management of patients with open abdomens is an evolving concept. • Certain techniques for managing the open abdomen patients can be effective in treating ACS. The goal of therapy is to maximize tissue perfusion and minimize potential intra abdominal complications, such as fistulas and hernias. Meticulous care of the bowel, minimizing trauma from techniques or systems used to cover abdominal contents and protection of the bowel from exposure to the environment can reduce the complications associated with the open abdomen. • A Temporal Abdominal Closure should not only protect the intra abdominal contents, but facilitate primary closure of the fascia and minimize the need for secondary repairs of ventral hernias and subsequent repair. • Serial bladder pressure monitoring should be a part of post-operative management protocols in high-risk patients and decompression of the abdomen with a pressure of > 25-30 mmHg should be considered even without clear clinical evidence of ACS. • While many closure techniques are reported in the literature, a dynamic closure technique, such as Vacuum pack appears to have an advantage in meeting most requirements for managing an open abdomen. • IAH and ACS remain the most significant considerations for the management of the open abdomen. IAH and ACS are in part iatrogenic and can be minimized with the appropriate resuscitation protocols. • Complications found in patients with open abdomens may be minimized with Vacuum pack Therapy resulting in early closure of the abdomen. • Consideration for the type of closure is based on the patient’s clinical status with the optimal result of primary facial closure. • When the fascia cannot be closed, skin over granulation tissue is preferred to skin grafting over granulation tissue to create ventral hernia • Several techniques have been described to repair created ventral hernias. In our work, three methods had been utilized for final reconstruction of complex midline anterior abdominal wall defects according to size of the defect and status of tissue bed ; (I) repair with autologous tissue to bridge the fascial gap using components separation technique (CST), (II) prosthetic repair to bridge fascial defects and (III) Shoelace Darn Repair • Proposed plan for management of complex midline anterior abdominal wall defects is shown in (figure 59). |