Subcutaneous Wound Management in Complex, Contaminated Abdominal Wall Reconstruction (AWR) - The "French Fry"...

Area of Science:

• Abdominal Wall Reconstruction
• Surgical Innovation
• Wound Management

Background:

• Primary closure of contaminated abdominal wall reconstruction (AWR) wounds has high complication rates.
• Vacuum-assisted, delayed primary closure (VADPC) improves outcomes but necessitates a second anesthetic.
• The French fry technique (FFT) aims to leverage vacuum-assisted closure benefits in a single stage.

Purpose of the Study:

• To evaluate the outcomes of the French fry technique (FFT) in complex, contaminated abdominal wall reconstruction (AWR).
• To assess wound complication rates associated with FFT in CDC class 2-4 wounds.
• To compare observed FFT complication rates with predictions from the Carolinas Equation for Determining Associated Risks (CeDAR).

Main Methods:

• Retrospective review of single-center open AWR cases (CDC class 2-4) managed with FFT.
• FFT involves placing subcutaneous "French fry" foam pieces within incisional negative pressure wound therapy (NPWT) at -125 mmHg.
• Foam "French fries" are removed on postoperative day 3, with NPWT continued.

Main Results:

• Twenty-seven patients with complex, contaminated AWR underwent FFT (mean defect size 384.2 cm²).
• Observed wound complication rate was 25.9%, significantly lower than the CeDAR-predicted rate of 53.8%.
• Infections occurred in 14.8%, with 7.4% requiring wound reopening; no mesh infections or hernia recurrences were observed.

Conclusions:

• The French fry technique (FFT) is a practical, single-stage strategy for contaminated AWR.
• FFT effectively reduces wound complications in complex cases compared to predicted risk.
• This technique offers the benefits of vacuum-assisted closure without requiring a second anesthetic procedure.