Stepwise plication of abdominal mesh technique for open abdomen closure

Area of Science:

• Abdominal surgery
• Wound healing
• Surgical techniques

Background:

• Delayed fascial closure is challenging in cases of excessive abdominal wall retraction.
• Existing methods may be invasive or less effective in resource-limited settings.

Purpose of the Study:

• To introduce the Stepwise Plication of Abdominal Mesh (SPAM) technique.
• To describe SPAM as a standardized dynamic closure method combining mesh-mediated fascial traction and negative pressure wound therapy for gradual abdominal wall approximation.

Main Methods:

• SPAM involves a central mesh incision with progressive tightening using hemostatic clamp rotation, avoiding full-thickness mesh cuts.
• The mesh is secured with continuous suture and covered with a non-commercial negative pressure system.
• Treatment cycles are repeated every 48-72 hours until fascial closure is achieved.

Main Results:

• SPAM was applied in four patients with peritoneostomy and excessive abdominal wall retraction.
• Three patients achieved primary fascial closure in a median of 10 days, with no enteroatmospheric fistula or incisional hernia.
• One patient experienced bleeding during traction, leading to discontinuation due to clinical deterioration.

Conclusions:

• SPAM is a practical, standardized, and reproducible approach for delayed fascial closure.
• The technique allows for controlled, progressive approximation without the need for mesh resection.
• SPAM is particularly suitable for resource-limited settings.