The Antiseptic Effect of VACWM Therapy: A Case Report

This case report illustrates that the continuous removal of inflammatory exudates from the abdomen might be a key factor in the treatment of septic shock in patients with an open abdomen. The vacuum assisted wound closure with mesh mediated traction technique has clearly proven his feasibility when it comes to closing rate of the abdomen. However, up to this moment, there is little evidence about the effect of continuous removal of inflammatory as cites on the septic status of the patient. Jens Goeteyn*, Aude Vanlander and Frederik Berrevoet Department of General and HPB Surgery and Liver Transplantation, Ghent University, Belgium Jens Goeteyn, et al. Annals of Clinical Case Reports Gastroenterology Remedy Publications LLC., | http://anncaserep.com/ 2016 | Volume 1 | Article 1174 2 pace (Figure 2). Biochemical inflammatory markers decreased rapidly after this moment. Discussion In recent years, laparotomy management has gone through various evolutions with the introduction of a wide variety of technical modifications [6]. Vacuum therapy is the most used TAC. Various studies have shown that VAC therapy is an excellent answer for IAH and ACS, drains the abdomen of exudate, reduces the rate of abscess formation and has a low incidence of intestinal fistula formation [2,5,10-12]. VAC systems alone, however, cannot prevent fascial retraction [6]. For this reason, it must be combined with another technique that facilitates approximation of the fascia. The combination of fascial traction and vacuum therapy has first been described in 2003 by Nasvaria et al. [13]. He combined retention sutures with a vacuum pack. Fantus et al. [14] described the use of the Wittmann patchTM in combination with vacuum pack. Pettersson et al. [4] was the first to combine a polypropylene mesh and vacuum-assisted closure system in a series of seven patients. Since this first pilot study, more studies have focused on the use of this novel VAWCM therapy. Acosta et al. [2] reported primary fascia closure of 76.6% in the intention-to-treat analyses. Intestinal fistulae occurred in 7.2% of the population. In a multivariate analysis, they found that age and failure of fascial closure were independently associated with in-hospital mortality. In a followup study by Bjarnason 66% of patients had an incisional hernia one year after OA treatment. No patients were documented with a giant ventral hernia [3]. A study by Kleif et al. [5] reports fascial closure only in 44% of patient. However, this was a small sample study and a mesh was only inserted when fascia closure deemed impossible to the surgeon with vacuum-assisted therapy alone. The ability of inflammatory as cites to propagate systemic inflammation has recently been the subject of many studies. Although there is no consensus about the specific pathway that causes severe A B