11.12 Novel Technique of Catastrophic Abdominal Wall Closure Utilizing Biologic Xenograft

Posted on January 31, 2019

Y. P. Puckett1, M. Estrada1, V. Tran1, J. Griswold1, B. Caballero1, R. Richmond1, A. Santos1, C. Ronaghan1  1Texas Tech University Health Sciences Center,Surgery,Lubbock, TX, USA

Introduction: Closure of catastrophic open abdominal wounds after damage control laparotomy presents a challenge to the surgeon. We present an alternative option for definitive fascial closure and accelerated wound healing of catastrophic open abdominal wounds utilizing novel technique combining a mechanical closure system with biologic xenograft.

Methods:  All patients that underwent abdominal wall closure with novel technique were analyzed between 2016-2018. ABRA® dynamic tissue system (DTS) was placed and adjusted daily until fascial closure was achieved. ACell MatriStem® urinary porcine bladder biologic enograft was placed in midline wound once fascial closure was achieved. Information was abstracted on age of patient, body mass index (BMI), incision length, myofascial gap size before and after DTS placement, visceral extrusion size, number of DTS adjustments, and total time to fascial closure. All procedures were performed in the operating room.

Results: Twenty three patients were analyzed. The average age of patient was 51 (Range 26.0-72.0) years. Mean BMI of patient was 35.30 (Range 21.0-56.1). Caucasians comprised 60.9% of the populations, Hispanics 30.4%, and African-Americans 8.7%. Ostomy was present in 47.8% of patients.The abdomen was open for an average of 9.32 (Range 0-35) days prior to application of DTS device. Delayed primary fascial closure was achieved in 100% of patients. An overall reduction in wound area was achieved in 100% of patients. There were zero surgical site infections observed. No patients developed incisional hernias or surgical site infections during this time period after a follow up of one year.

Conclusion: Utilization of DTS in conjunction with biologic xenograft combines both mechanical and biologic advantage in closing complex abdominal wounds. More research needed in performing a cost analysis for this procedure.