Sandwich mesh abdominal closure

The open abdomen carries a high mortality rate and represents a big surgical challenge. The recent introduction of vacuum assisted closure (VAC) introduced new techniques of its management, including STAR--Staged Abdominal Repair, Fabian Protocol, VAC supported with PDS, support with polyglactin mesh and the use of tissue expanders in the staged closure of the open abdomen. One of the methods, SMAC--sandwich mesh abdominal closure, emerged in April 2008 by the clinical group from Germany. The authors present their own modification of SMAC and a case report, where it was used. By current literary research it was the first patient in the Central European hospital managed by SMAC VAC. The authors of the article conclude that SMAC VAC and its modification is highly effective in the management of the open abdomen (Fig. 5, Ref. 4).