Vacuum-assisted closure for complicated neonatal abdominal wounds
Gregory Lopez1, Robin Clifton-Koeppel, Sherif Emil
1Division of Pediatric Surgery, University Children's Hospital, University of California Irvine School of Medicine, Orange, CA 92868, USA.
Background:
Neonatal experience in vacuum-assisted closure (VAC) for complex abdominal wounds remains scant.
Methods:
A neonatal VAC protocol was instituted in 2004. The medical records of patients treated with this protocol for the ensuing 3 years were retrospectively reviewed. Continuous data are reported as mean +/- SD (range).
Results:
Ten VAC applications occurred in 8 neonates for a 3-year period. Gestational age and age at VAC application were 30 +/- 6.9 (24-40) weeks and 84.5 +/- 51 (21-165) days, respectively. Birth weight and weight at VAC application were 1495 +/- 1118 (615-3415) g and 3515 +/- 2118 (989-7965) g, respectively. All wound complications occurred after laparotomies (7 elective, 3 emergent). Three wounds included intestinal stomas, and 3 included enterocutaneous fistulae. Average wound area at VAC initiation was 13.6 +/- 6.0 (8.5-25) cm(2). Duration of VAC use was 19.1 +/- 15.3 (7-60) days. Vacuum-assisted closure resulted in complete wound closure in all cases and did not result in any local or systemic complications. Five patients (63%) survived to discharge.
Conclusions:
Vacuum-assisted closure for complicated abdominal wounds is safe and successful in neonates of any gestational age and birth weight. It provides effective wound management, even in the presence of stomas or enterocutaneous fistulae.
