Closing the open abdomen: improved success with Wittmann Patch staged abdominal closure

Area of Science:

• Trauma Surgery
• Surgical Devices
• Abdominal Wall Reconstruction

Background:

• The "open abdomen" approach improves trauma patient outcomes but presents challenges in fascial closure.
• Fascial closure remains a significant challenge following open abdomen management in trauma care.
• The Wittmann Patch was introduced in 2004 for staged abdominal closure in open abdomen cases.

Purpose of the Study:

• To evaluate the impact of the Wittmann Patch on fascial closure rates.
• To compare the incidence of planned ventral hernia repair before and after Wittmann Patch implementation.
• To assess the safety and efficacy of the Wittmann Patch in open abdomen management.

Main Methods:

• A retrospective review of open abdomen patients from 2001-2006.
• Comparison of patients managed before (pre-Patch) and after (Patch era) Wittmann Patch adoption.
• Defined "early fascial closure" and "delayed fascial closure" for analysis.

Main Results:

• The Wittmann Patch era saw 103 open abdomens versus 56 in the pre-Patch era.
• Delayed fascial closure incidence significantly increased with the Wittmann Patch (78% vs. 30%, p < 0.001).
• Planned ventral hernia rates decreased significantly in the Patch era (8% vs. 29%, p < 0.001) with similar complication rates.

Conclusions:

• The Wittmann Patch incorporation increased delayed fascial closure rates in open abdomen management.
• The device demonstrated efficacy and safety, with comparable abdominal complication rates between groups.
• This approach reduces the need for planned ventral hernia repair in trauma patients.