الفهرس 
IntroductionOnly 14 pages are availabe for public view
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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).