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Negative pressure wound therapy for children with an open abdomen
Ivan M Gutierrez1, Gerald Gollin
1Division of Pediatric Surgery, Loma Linda University School of Medicine, 11175 Campus St., CP 21111, Loma Linda, CA 92354, USA.
Insights
Negative pressure wound therapy (NPWT) effectively manages open abdomens in pediatric patients, facilitating wound healing and successful abdominal closure in survivors. This approach proves reliable for infants and children requiring complex abdominal wound care.
Area of Science:
- Pediatric Surgery
- Wound Management
- Critical Care Medicine
Background:
- Negative pressure wound therapy (NPWT) is established for adult open abdomen management.
- Limited data exists on NPWT's efficacy in pediatric open abdomen cases.
Purpose of the Study:
- To evaluate the experience of using NPWT for open abdomens in infants and children.
- To assess NPWT's role in wound healing and abdominal closure in pediatric patients.
Main Methods:
- Retrospective review of pediatric patients treated with NPWT for open abdomen (March 2005 - September 2009).
- Utilized the vacuum-assisted closure (VAC®) system for all patients.
- Analyzed outcomes including duration of therapy, abdominal closure success, and complications.
Main Results:
- Twenty-five pediatric subjects were identified with open abdomens due to abdominal compartment syndrome or inability to close.
- Median NPWT duration was 4.5 days; 16 subjects achieved successful abdominal closure.
- Nine subjects died before closure; only two (12.5%) developed enterocutaneous fistulae.
Conclusions:
- NPWT is a dependable method for managing open abdomens in pediatric populations.
- Facilitated wound care and successful abdominal closure in surviving children.
- Low incidence of enterocutaneous fistulae suggests NPWT is safe and effective for pediatric open abdomens.
Purpose:
The utility of negative pressure wound therapy (NPWT) in the management of adults with an open abdomen has been well documented. We reviewed our experience with NPWT in the management of infants and children with this condition.
Methods:
The records of all children who were treated with NPWT for an open abdomen between March 2005 and September 2009 at a single children's hospital were reviewed.
Results:
Twenty-five subjects were identified. They included children who developed abdominal compartment syndrome after a laparotomy (n = 12) or in whom the abdomen could not be safely closed at the time of laparotomy (n = 13). NWPT was accomplished with the vacuum-assisted closure (VAC®) system in all patients. The median duration for NPWT was 4.5 days. In 16 subjects, the abdomen was closed successfully after NPWT. In 14 children, the abdominal wall fascia was successfully approximated, and two children underwent a patch abdominal closure. But nine subjects died before an abdominal closure could be attempted. Only two (12.5%) children developed enterocutaneous fistulae.
Conclusions:
NPWT is a reliable tool for infants and children with an open abdomen. Wound management was facilitated and abdominal wall closure was ultimately achieved in all survivors. Enterocutaneous fistulae developed in two children, however, these were likely due to underlying bowel injury and would have occurred despite variations in management of the open abdomen.
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Assessment:
1. Clinical Evaluation:
History: