Delayed Primary Closure in Damage Control Laparotomy: The Value of the Wittmann Patch

Hadeed, Josef G.; Staman, Gregory W.; Sariol, Hector S.; Kumar, Sanjay; Ross, Steven E.
January 2007
American Surgeon;Jan2007, Vol. 73 Issue 1, p10
Academic Journal
Damage control laparotomy has become an accepted practice in trauma surgery. A number of methods leading to delayed primary closure of the abdomen have been advocated; complications are recognized with all these methods. The approach to staged repair using the Wittmann patch (Star Surgical Inc., Burlington, WI) combines the advantages of planned relaparotomy and open management, while minimizing the rate of complications. The authors hypothesized that use of the Wittmann patch would lead to a high rate of delayed primary closure of the abdomen. The patch consists of two sheets sutured to the abdominal fascia, providing for temporary closure. Advancement of the patch and abdominal exploration can be done at bedside. When the fascial edges can be reapproximated without tension, abdominal closure is performed. Twenty-six patients underwent staged abdominal closure during the study period. All were initially managed with intravenous bag closure. Eighty-three per cent (20 of 24) went on to delayed primary closure of the abdomen, with a mean time of 13.1 days from patch placement to delayed primary closure. The rate of closure using the Wittmann patch is equivalent to other commonly used methods and should be considered when managing patients with abdominal compartment syndrome or severe abdominal trauma.


Related Articles

  • Multiple Laparotomies Are a Predictor of Fascial Dehiscence in the Setting of Severe Trauma. Swaroop, Mamta; Williams, Michael; Greene, Wendy ricketts; Sava, Jack; Park, Kenneth; Wang, Dennis // American Surgeon;May2005, Vol. 71 Issue 5, p402 

    The purpose of this study was to determine the incidence of wound dehiscence after repeat trauma laparotomy. We performed a retrospective analysis of adult trauma patients who underwent laparotomy at an urban level 1 trauma center during the past 5 years. Patients were divided into single (SL)...

  • Linea Alba Fasciotomy: A Novel Alternative in Trauma Patients with Secondary Abdominal Compartment Syndrome. DUCHESNE, JUAN C.; HOWELL, MEGHAN P.; ERIKSEN, CALVIN; WAHL, GEORGIA M.; RENNIE, KELLY V.; HASTINGS, PAUL E.; MCSWAIN JR., NORMAN E.; MALBRAIN, MANU L. // American Surgeon;Mar2010, Vol. 76 Issue 3, p312 

    Polytrauma patients needing aggressive resuscitation can develop intra-abdominal hypertension (IAH) with subsequent secondary abdominal compartment syndrome (SACS). After patients fail medical therapy, decompressive laparotomy is the surgical last resort. In patients with severe pancreatitis...

  • fasciotomy. Peters, Michael // BMA A-Z Family Medical Encyclopedia;2004, p299 

    An encyclopedia entry for the term "fasciotomy" is presented. It refers to the operation which aims to ease pressure on muscles through an making an incision in the fascia that surrounds them. It notes that fasciotomy can treat compartment syndrome, a painful condition in which constriction of a...

  • Delayed Primary Closure of the Septic Open Abdomen with a Dynamic Closure System. Verdam, Froukje J.; Dolmans, Dennis E. J. G. J.; Loos, Maarten J.; Raber, Menno H.; de Wit, Ralph J.; Charbon, Jan A.; Vroemen, Jos P. A. M. // World Journal of Surgery;Oct2011, Vol. 35 Issue 10, p2348 

    Background: The major challenge in the management of patients with an infected open abdomen (OA) is to control septic peritonitis and intra-abdominal fluid secretion, and to facilitate repeated abdominal exploration, while preserving the fascia for delayed primary closure. We here present a...

  • Abdominoplasty Technique Offers New Mothers Their "Pre-Baby" Figures. Bedevian, Rima // Plastic Surgery Products;Aug2008, Vol. 18 Issue 9, p10 

    The article focuses on Hybrid Tummy Tuck, an abdominoplasty technique introduced by plastic surgeon Doctor Brent Moelleken, which gets rid of the loose skin after pregnancy. Moelleken explains that the technique tightens the lining of the abdominal muscles, or fascia, through an incision about...

  • Comparison of ultrasonography and physical examination in the diagnosis of incisional hernia in a prospective study. Bloemen, A.; Dooren, P.; Huizinga, B.; Hoofwijk, A. // Hernia;Feb2012, Vol. 16 Issue 1, p53 

    Purpose: Incisional hernia is a frequent complication of abdominal surgery (incidence 2-20%). Diagnosis by physical examination is sometimes difficult, especially in small incisional hernias or in obese patients. The additional diagnostic value of standardized ultrasonography was evaluated in...

  • Staged abdominal repair (STAR) operation: How I Did it. Biswajit, Mohapatra // Indian Journal of Surgery;May/Jun2004, Vol. 66 Issue 3, p182 

    STAR is a technique of serial operation, planned either before or during the first index operation and performed every 24 to 48 hrs or as required, with temporary closure of abdomen and ending in a final aponeurosis to aponeurosis closure of abdomen. During the course of treatment a controlled...

  • Abdominal Kompartman Sendromunda Beslenme. Kelebek Girgin, Nermin // Journal of the Turkish Society of Intensive Care / Türk Yogun B;2012 Supplement, Vol. 10, p33 

    Intraabdominal hypertension (IAH) has been increasingly recognized as both cause and consequence of many adverse events in critically ill patients. It results in decreased intestinal pH, bowel oedema, ileus and enteral feeding intolerance. The first choice is enteral feeding (EF) in patient with...

  • The Abdominal Compartment Syndrome: Enteric Feeding May Prolong Closure. Perry, Charles W.; Phillips, Bradley J. // Internet Journal of Surgery;2003, Vol. 4 Issue 1, p35 

    Patients with an open abdomen who receive post-operative enteric nutritional support may have a delay in subsequent abdominal wall closure. To address this possibility, a retrospective study of twenty-four consecutive trauma patients was conducted. Subsequent analysis revealed that...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics