Negative Pressure Wound Therapy

The purpose of this review was to evaluate mortality rates of open abdomen patients with severe peritonitis who received negative pressure therapy (NPT) versus open packing techniques as a method of temporary abdominal closure (TAC). Authors retrospectively reviewed consecutive records from five different surgical departments of patients who received NPT (V.A.C. technology) and open packing (OP) following severe secondary peritonitis. Patient demographics, number of days in ICU, and mortality were recorded and analyzed. Medical records of 239 patients were analyzed. The APACHE II score was significantly higher for the VAWD group (p<0.002). Mortality rates were significantly higher for the OP group (76%), compared to 37% and 36% for the CV and VAWD groups, respectively (p<0.01). The number of days in ICU was highest in the OP group (38.6), compared to 30.0 for CV and 36.4 for VAWD, but the difference was not significant. An algorithm to guide NPT use in this patient population is presented. Results suggest that the application of NPT in the open abdomen following diffuse peritonitis may significantly reduce patient mortality, compared to open packing techniques. NPT appears to be a safe and viable method of temporary abdominal closure in open abdomen following severe peritonitis.