Wittmann Patch : Superior Closure for the Open Abdomen
Hannah M Nemec1, D Benjamin Christie1, Anne Montgomery1
1Department of Surgery, The Medical Center Navicent Health/Mercer University School of Medicine, Macon, GA, USA.
The American Surgeon
|August 12, 2020
Summary
The Wittmann Patch (WP) device achieved higher rates of primary and delayed fascial closure for open abdomens after damage control laparotomy compared to the ABThera (AB) device, with fewer complications.
Area of Science:
- Surgical techniques and patient outcomes
- Trauma surgery and critical care
Background:
- Damage control laparotomy (DCL) is critical but results in open abdomens (OA), associated with significant morbidity and mortality.
- Current management of OAs lacks standardized closure versus coverage techniques, leading to varied patient outcomes.
- Observed differences in outcomes between Wittmann Patch (WP) and ABThera (AB) devices prompted this investigation.
Purpose of the Study:
- To compare the efficacy of the Wittmann Patch (WP) versus ABThera (AB) in achieving fascial closure for open abdomens following DCL.
- To test the hypothesis that the WP device improves fascial closure rates compared to the AB device.
Main Methods:
- Retrospective review of patients undergoing DCL and OA management between 2011 and 2019 at a Level 1 trauma center.
- Patients were categorized into two groups: those managed with ABThera (AB) alone or Wittmann Patch (WP).
- Primary fascial closure (PFC) and delayed fascial closure (DFC, >7 days) were the primary endpoints.
Main Results:
- The study included 189 patients in the AB group and 38 in the WP group; baseline characteristics were similar.
- Wittmann Patch (WP) demonstrated statistically significant higher rates of primary fascial closure (PFC: 90% vs 81%) and delayed fascial closure (DFC: 100% vs 44%) compared to ABThera (AB).
- Excluding patients with prior hernias, WP showed superior PFC (100% vs 87%) and DFC (100% vs 44%) rates (P < .05 and P ≤ 0.001, respectively), with fewer complications.
Conclusions:
- The Wittmann Patch (WP) facilitates active fascial closure for open abdomens, contrasting with the ABThera (AB) device's role primarily as a coverage solution.
- Institutional data indicate superior rates of primary and delayed fascial closure and reduced complications with WP management compared to AB.
- WP represents a more effective approach for achieving fascial closure in the management of open abdomens post-DCL.
