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Clinical Research
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Use of negative pressure wound therapy in the management of infected abdominal wounds with exposed mesh: an analysis of outcomes First Author: Mona Baharestani, PhD Authors: Mona Baharestani, PhD, ANP, CWOCN, CWS, FCCWS, FAPWCA Abdominal wall defects most commonly result from trauma, prior surgery, necrotizing fascial infections or ‘damage control procedures'. In the absence of fascia, or when reapproximation without tension is not possible, prosthetic meshes are utilized to maintain abdominal wall integrity. Wound bed preparation typically consists of multiple debridements and packing with moistened gauze until granulation tissue is established. The time to achieve ultimate closure can span from weeks, to years when infection is present. A non-randomized, retrospective review of 21 patients diagnosed with infected abdominal wounds containing exposed mesh who were treated with V.A.C.ª was performed. Pre-V.A.C.ª, the mean wound duration by mesh type was: Composite 68 days (range 24-171), Marlex 59 days (range 32-119) and Vicryl 19.4 days (range 12-39). Average LOS pre-V.A.C.ª was 76, 51 and 19 for Composite, Marlex and Vicryl respectively. Average V.A.C.ª treatment days for wounds with exposed Composite mesh was 24 (LOS 27), 20 days for Marlex (LOS 27) and 28 days for Vicryl (LOS 32).Pre-V.A.C.ª 14 patients were admitted for drainage of abscesses (19 such admissions). Fifteen patients underwent operative partial mesh debridements pre-V.A.C.ª (25 admissions). Total mesh extractions were performed in 5 patients pre-V.A.C.ª. Sixty-three percent of patients with Composite mesh underwent total mesh extraction followed by V.A.C.ª and all subsequently healed. None of the 37.5% of patients with Composite mesh left in-situ, achieved complete closure after V.A.C.ª, although all exhibited decreased dimensions and increased granulation. V.A.C.ª, when coupled with appropriate systemic antibiotics and nutritional optimization in the treatment of patients with infected abdominal wounds resulted in rapid and 86% successful closure with decreases in LOS, operative procedures and readmissions |
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