Transport of the Open Abdomen: A Review

An open abdomen (OA) is a critical surgical condition in which the abdominal wall is intentionally left open to prevent or manage intra-abdominal hypertension or abdominal compartment syndrome or facilitate staged re-exploration. Although OA management is well described in surgical literature, the safe transport of patients with an OA-particularly in air medical and critical care transport settings-presents unique challenges that are less frequently addressed.

This review summarizes current evidence and best practices for the transport of patients with an OA, focusing on physiologic considerations, temporary abdominal closure (TAC) methods, equipment, monitoring, and emergency management during interfacility transfer.

Key elements of OA transport include secure and intact TAC devices, vigilant monitoring of hemodynamic and ventilatory parameters, and preparedness for complications such as vacuum-assisted closure failure, re-elevated intra-abdominal pressure, and hemodynamic decompensation. Coordination between surgical, critical care, and transport teams is essential. The review details the advantages and limitations of TAC options-such as negative pressure wound therapy, Bogotá bags, and Wittmann patches-and outlines practical recommendations for troubleshooting and in-flight stabilization.

Transporting patients with an OA requires specialized knowledge of pathophysiology, meticulous preparation, and clear communication among multidisciplinary teams. Establishing standardized protocols and incorporating OA-specific competencies into air medical training can enhance patient safety and outcomes during these complex transfers.