Management of fistula of ileal conduit in open abdomen by intra-condoit negative pressure system

INTRODUCTION

We aimed to present the management of a patient with fistula of ileal conduit in open abdomen by intra-condoid negative pressure in conjunction with VAC Therapy and dynamic wound closure system (ABRA).

PRESENTATION OF CASE

65-Year old man with bladder cancer underwent radical cystectomy and ileal conduit operation. Fistula from uretero-ileostomy anastomosis and ileus occurred. The APACHE II score was 23, Mannheim peritoneal index score was 38 and Björck score was 3. The patient was referred to our clinic with ileus, open abdomen and fistula of ileal conduit. Patient was treated with intra-conduid negative pressure, abdominal VAC therapy and ABRA.

DISCUSSION

Management of urine fistula like EAF in the OA may be extremely challenging. Especially three different treatment modalities of EAF are established in recent literature. They are isolation of the enteric effluent from OA, sealing of EAF with fibrin glue or skin flep and resection of intestine including EAF and re-anastomosis. None of these systems were convenient to our case, since urinary fistula was deeply situated in this patient with generalized peritonitis and ileus.

CONCLUSION

Application of intra-conduid negative pressure in conjunction with VAC therapy and ABRA is life saving strategies to manage open abdomen with fistula of ileal conduit.     

Vacuum drainage in the management of complicated abdominal wound dehiscence in children

Purpose

The aim of the study was to report the outcomes of the vacuum dressing method (vacuum-assisted closure [VAC]) in the management of “complicated” abdominal wounds in a selected group of children including neonates.

Methods

All children with vacuum (VAC) dressing-assisted closure of a complex abdominal wound (defined as complete/partial wound dehiscence combined with at least one of stoma, anastomosis, tube enterostomy, or infected patch abdominoplasty) were included in a 2-year study that took place in a single tertiary referral hospital. Retrospective case note analysis was used to determine premorbid diagnosis, management, illness severity markers, morbidity, and outcome.

Results

Nine children (neonate to 16 years) required 11 continuous episodes of VAC therapy. Abdominal wall dehiscence was complete in 7 and partial in 4 episodes. These were complicated by stomas (8), anastomoses (3), enterocutaneous fistulae (3), tube enterostomy (1), and infected patch abdominoplasty (2). Illness severity was assessed by the following proxy physiologic markers: American Society of Anesthesiologists status 3 or more (10), intensive care unit (ICU) (7), inotropes (4), ventilation (7), septic (C-reactive protein >100 and blood culture-positive) (3), liver impairment (aspartate transaminase >58 and alanine transaminase >36) (4), coagulopathy (international normalized ratio >1.3) (4), proinflammatory state (platelet count >450) (5), and nutritional impairment (albumin <37) (9). The median VAC treatment time was 32 days (range, 9-101 days). Of the changes, 70% required a general anesthetic or sedation on ICU. Control of 10 of 11 complex abdominal wounds (including 3 established enterocutaneous fistulae) was achieved using VAC therapy. Complications included nonreduction of laparostomy (1), failure of anastomosis (1), and failure of tube enterostomy diversion (1). Four children died of unrelated causes, 2 of them more than 3 months after VAC therapy.

Conclusions

In our experience with a small series of patients, VAC therapy is both safe and effective in complex pediatric abdominal wounds in severely ill children. It appears to promote wound closure, controls local sepsis, and can be used to manage established fistulae. However, our results suggest that recent bowel anastomoses may be compromised using VAC, which in this circumstance, should be used with caution.     

A review of topical negative pressure therapy in wound healing: sufficient evidence?

Background

Topical negative pressure (TNP) therapy has become a useful adjunct in the management of various types of wounds. However, the TNP system still has characteristics of a “black box” with uncertain efficacy for many users. We extensively examined the effectiveness of TNP therapy reported in research studies.

Data sources

A database search was undertaken, and over 400 peer-reviewed articles related to the use of TNP therapy (animal, human, and in vitro studies) were identified.

Conclusions

Almost all encountered studies were related to the use of the commercial VAC device (KCI Medical, United States). Mechanisms of action that can be attributed to TNP therapy are an increase in blood flow, the promotion of angiogenesis, a reduction of wound surface area in certain types of wounds, a modulation of the inhibitory contents in wound fluid, and the induction of cell proliferation. Edema reduction and bacterial clearance, mechanisms that were attributed to TNP therapy, were not proven in basic research.     

Vacuum-assisted closure for complicated neonatal abdominal wounds

Background

Neonatal experience in vacuum-assisted closure (VAC) for complex abdominal wounds remains scant.

Methods

A neonatal VAC protocol was instituted in 2004. The medical records of patients treated with this protocol for the ensuing 3 years were retrospectively reviewed. Continuous data are reported as mean ± SD (range).

Results

Ten VAC applications occurred in 8 neonates for a 3-year period. Gestational age and age at VAC application were 30 ± 6.9 (24-40) weeks and 84.5 ± 51 (21-165) days, respectively. Birth weight and weight at VAC application were 1495 ± 1118 (615-3415) g and 3515 ± 2118 (989-7965) g, respectively. All wound complications occurred after laparotomies (7 elective, 3 emergent). Three wounds included intestinal stomas, and 3 included enterocutaneous fistulae. Average wound area at VAC initiation was 13.6 ± 6.0 (8.5-25) cm². Duration of VAC use was 19.1 ± 15.3 (7-60) days. Vacuum-assisted closure resulted in complete wound closure in all cases and did not result in any local or systemic complications. Five patients (63%) survived to discharge.

Conclusions

Vacuum-assisted closure for complicated abdominal wounds is safe and successful in neonates of any gestational age and birth weight. It provides effective wound management, even in the presence of stomas or enterocutaneous fistulae.     

Use of dynamic wound closure system in conjunction with vacuum-assisted closure therapy in delayed closure of open abdomen

Aim

Definitive abdominal closure may not be possible for several days or weeks after laparotomy in damage-control surgery, abdominal compartment syndrome and intraabdominal sepsis, until the patient has stabilized. Vacuum-assisted closure (VAC therapy^®, KCI, San Antonio, TX, USA) and abdominal re-approximation anchor system (ABRA, Canica, Almonte, Ontario, Canada) are novel techniques in delayed closure of open abdomen. Our aim is to present the use of these strategies in the management of 7 patients with open abdomen.

Methods

Between August 2010 and December 2011, 7 patients with severe peritonitis were stabilized by laparotomy and treated with either ABRA system or ABRA system in conjunction with VAC dressing. VAC dressing applied to 4 patients initially and followed by ABRA. ABRA was applied alone to remaining 3 patients. Demographic data and patient characteristics, timing of VAC dressing and ABRA system were recorded. ICU and hospital stay and development of incisional hernia were also recorded. Stage of open abdomen, width of abdominal defect, extent to damage to fascia, and pressure sores were staged.

Results

The mean duration with VAC dressing before ABRA application was 18 days. The mean duration of ABRA application was 53 days. The average width of the abdominal defect was 18 cm. The average length of defect was 20.8 cm. Delayed primary abdominal closure was accomplished in 6 patients without further surgery. Incisional hernia with a small abdominal defect developed in 2 patients.

Conclusion

Abdominal re-approximation anchor system and VAC dressing can be used separately or in conjunction with each other for closure of delayed open abdomen successfully.     

Negative pressure wound therapy for children with an open abdomen

Purpose

The utility of negative pressure wound therapy (NPWT) in the management of adults with an open abdomen has been well documented. We reviewed our experience with NPWT in the management of infants and children with this condition.

Methods

The records of all children who were treated with NPWT for an open abdomen between March 2005 and September 2009 at a single children’s hospital were reviewed.

Results

Twenty-five subjects were identified. They included children who developed abdominal compartment syndrome after a laparotomy (n?=?12) or in whom the abdomen could not be safely closed at the time of laparotomy (n?=?13). NWPT was accomplished with the vacuum-assisted closure (VAC®) system in all patients. The median duration for NPWT was 4.5 days. In 16 subjects, the abdomen was closed successfully after NPWT. In 14 children, the abdominal wall fascia was successfully approximated, and two children underwent a patch abdominal closure. But nine subjects died before an abdominal closure could be attempted. Only two (12.5%) children developed enterocutaneous fistulae.

Conclusions

NPWT is a reliable tool for infants and children with an open abdomen. Wound management was facilitated and abdominal wall closure was ultimately achieved in all survivors. Enterocutaneous fistulae developed in two children, however, these were likely due to underlying bowel injury and would have occurred despite variations in management of the open abdomen.     

Wound management with vacuum-assisted closure: experience in 51 pediatric patients

Background/Purpose

Soft tissue loss from infectious, vascular, and traumatic disorders often results in poor healing, painful wound care, and the need for repeated operations. This retrospective study evaluates a single-institutional experience with negative pressure therapy (NPT), using the vacuum-assisted closure (VAC) device in a group of children with diverse soft tissue problems.

Methods

The medical records of 51 patients treated with NPT from January 2000 to July 2003 were reviewed for demographics, diagnosis, duration of VAC therapy, wound closure, recurrent disease, and complications.

Results

Patients were classified by diagnosis: group 1: pilonidal disease (n = 21, primary = 6 and recurrent = 15); group 2: sacral and extremity ulcers (n = 9); group 3: traumatic soft tissue wounds (n = 9); and group 4: extensive tissue loss (n = 12) from the abdominal wall (n = 7), perineum (n = 2), thigh (n = 2), and axilla (n = 1). Group 1 had an average age of 16 years (range, 10-20 years), 67% were obese, and had an average length of follow-up of 13 months (range, 8-36 months). VAC was placed in the operating room in 95% with subsequent outpatient care that included dressing change 3 times weekly. Healing occurred in all patients with primary disease at an average of 37 days. For patients with recurrent disease, 12 healed at an average of 48 days and 3 developed recurrent sinuses. Group 2 was treated with VAC as a bridge to skin grafting or flap closure. All children in group 3 achieved healing without skin grafting at an average of 10 days and with acceptable cosmesis. Negative pressure therapy in group 4 was the only wound treatment in 10 patients and adjunctive to operative closure in 2. Complications from VAC occurred in 5 patients: retained sponge in 2 and device malfunction in 3.

Conclusions

Negative pressure therapy offers a safe, cost-effective alternative to traditional complex wound care in children. Its advantages are less frequent dressing changes, outpatient management, resumption of daily activities including return to school, and a high degree of patient tolerance.     

Fluid volume overload negatively influences delayed primary facial closure in open abdomen management

Background and aim

The open abdomen (OA) is associated with significant morbidity and mortality, and its management poses a formidable challenge. Inability to achieve primary closure of the abdominal wall is one of the most severe complications of this technique. Factors influencing primary fascial closure, however, are unknown. This study aims to explore the influence of fluid volume overload on the application of vacuum-assisted and mesh-mediated fascial traction (VAWCM) in OA treatment.

Methods

A review of patients undergoing OA management using VAWCM technique from January 2006 to November 2011 was performed. Patients with aged <18 y OA treatment for fewer than 5 d and abdominal wall hernia before OA treatment were excluded.

Results

Average age was 45 ± 10.1 y and average OA treatment time was 31 ± 6.8 d. The complete fascial closure rate was 60%. The overall mean bodyweight-based fluid overload was 7.2 kg (range: −8.0 to +21.6 kg), representing a mean percent weight gain of 11.5% (range: −9.5% to +27%). Patients with fluid-related weight gain ≥10% had a lower primary facial closure rate than those with <10% (39% versus 77%). And primary facial closure rate seems to further decrease with fluid-related weight gain ≥20%, suggesting a dose-response effect of progressive fluid accumulation.

Conclusions

The VAWCM method provided a high primary fascial closure rate after long-term treatment of OA. Fluid volume overload negatively influences delayed primary facial closure. Judicious intravenous fluid resuscitation should be advocated in the therapy of critically ill patients.     

Staged management of the open abdomen and enteroatmospheric fistulae using split-thickness skin grafts

Background

Management of the open abdomen with polyglactin 910 mesh followed by split-thickness skin grafts allows safe, early closure of abdominal wounds. This technique can be modified to manage enteroatmospheric fistulae. Staged ventral hernia is performed in a less inflamed surgical field.

Methods

A retrospective review was performed of 59 consecutive patients who underwent abdominal skin grafting for open abdominal wounds from 2001 to 2011.

Results

The median length of follow-up was 215 days. Thirty-one percent of patients presented with preexisting enteroatmospheric fistulae, and 41% required polyglactin 910 mesh placement before skin grafting. Partial or complete skin graft failure occurred in 7 patients. Four patients required repeat skin grafting. All patients ultimately achieved abdominal wound closure, and none developed de novo fistulae.

Conclusions

With proper technique, skin grafting of the open abdomen with a planned ventral hernia repair is a safe and effective alternative to delayed primary closure.     

Early Versus Delayed Source Control in Open Abdomen Management for Severe Intra-abdominal Infections: A Retrospective Analysis on 111 Cases

Background

Time to source control plays a determinant prognostic role in patients having severe intra-abdominal infections (IAIs). Open abdomen (OA) management became an effective treatment option for peritonitis. Aim of this study was to analyze the correlation between time to source control and outcome in patients presenting with abdominal sepsis and treated by OA.

Methods

We retrospectively analyzed 111 patients affected by abdominal sepsis and treated with OA from May 2007 to May 2015. Patients were classified according to time interval from first patient evaluation to source control. The end points were intra-hospital mortality and primary fascial closure rate.

Results

The in-hospital mortality rate was 21.6% (24/111), and the primary fascial closure rate was 90.9% (101/111). A time to source control ≥6 h resulted significantly associated with a poor prognosis and a lower fascial closure rate (mortality 27.0 vs 9.0%, p = 0.04; primary fascial closure 86 vs 100%, p = 0.02). We observed a direct increase in mortality (and a reduction in closure rate) for each 6-h delay in surgery to source control.

Conclusion

Early source control using OA management significantly improves outcome of patients with severe IAIs. This damage control approach well fits to the treatment of time-related conditions, particularly in case of critically ill patients.

     

Managing the open abdomen: negative pressure closure versus mesh-mediated fascial traction closure: a randomized trial

Purpose

To compare the effectiveness of abdominal wall closure using the vacuum-assisted closure (NPC) as described by Barker et al. with an institutional protocol using a double polyvinyl bag in the first surgery, which is changed in subsequent surgeries to a polyvinyl bag placed over the bowel loops and a prolene mesh attached to the abdominal fascia (MMFC).

Methods

Randomized controlled trial. Patients with open abdomen (OA) due to a traumatic or a medical cause were included in the study. Variables studied included demographics, indication for surgery, number of interventions, hospital length of stay (HLOS), ICU length of stay, abdominal wound care costs, complication rates, and method and time to definitive fascial closure.

Results

From June 2011 to April 2013, 75 patients were enrolled in the study. Patients who died within 48 h were excluded; therefore, 53 patients in total were assessed. NPC achieved fascial closure in 75 % of patients, and MMFC achieved closure in 71.9 % of patients. The closure rates in patients with OA secondary to medical causes (80 % by NPC vs. 71.4 % by MMFC) or traumatic causes (70 % by NPC vs. 73.7 % by MMFC) were similar in both treatment groups. There were no differences between the groups with respect to cause of OA, complications, length of hospital stay, or the length of stay in the intensive care unit.

Conclusion

MMFC is a method comparable to NPC for the temporary management of OA that results in similar closure and complication rates.

     

Managing the open abdomen with vacuum-assisted closure therapy: retrospective evaluation of 22 patients

BACKGROUND: The authors reviewed their experience in the management of "open abdomen" using the vacuum-assisted closure device (VAC), in order to assess its morbidity particularly in terms of fistula, and the outcome of abdominal wall integrity. METHODS: Between January 2003 and October 2006, 22 patients required management with an "open abdomen" technique (18 patients were managed with the VAC abdominal dressing device with application of a specific sheet and 4 other patients simply required a dressing with the polyurethane sponge). The mean age was 55 years, and M/F sex ratio was 2.67. Indications were abdominal compartment syndrome in 7 patients, initial "abdominal closure" after trauma in one patient, severe abdominal sepsis in 7 patients, and abdominal wound dehiscence where closure was impossible in 7 patients. RESULTS: There were no enteric fistulae. Two infections were seen--a chronic suppuration which resolved with antibiotic therapy and a deep abscess which was drained with radiologic guidance. Of the 18 cases of "open abdomen" managed with the VAC, 15 were alive. Six (40%) underwent a delayed primary closure at a mean interval of 9 days; the others underwent secondary healing by granulation, and 10 eventually underwent split thickness skin grafting at a mean interval of 50 days. With VAC closure of the "open abdomen", the development of ventral hernia is an anticipated outcome; in four cases, patients underwent abdominal wall reconstruction at an interval of one year. CONCLUSION: Laparostomy or "open abdomen" using the VAC dressing system should be considered an established and well-defined technique which provides temporary abdominal coverage with limited morbidity.     

Open Abdomen Treatment with Dynamic Sutures and Topical Negative Pressure Resulting in a High Primary Fascia Closure Rate

Background

Open abdomen (OA) treatment with negative-pressure therapy is a novel treatment option for a variety of abdominal conditions. We here present a cohort of 160 consecutive OA patients treated with negative pressure and a modified adaptation technique for dynamic retention sutures.

Methods

From May 2005 to October 2010, a total of 160 patients—58 women (36?%); median age 66?years (21–88?years); median Mannheim peritonitis index 25 (5–43) underwent emergent laparotomy for diverse abdominal conditions (abdominal sepsis 78?%, ischemia 16?%, other 6?%).

Results

Hospital mortality was 21?% (13?% died during OA treatment); delayed primary fascia closure was 76?% in the intent-to-treat population and 87?% in surviving patients. Six patients required reoperation for abdominal abscess and five patients for anastomotic leakage; enteric fistulas were observed in five (3?%) patients. In a multivariate analysis, factors correlating significantly with high fascia closure rate were limited surgery at the emergency operation and a Bj?rk index of 1 or 2; factors correlating significantly with low fascia closure rate were male sex and generalized peritonitis.

Conclusions

With the aid of initially placed dynamic retention sutures, OA treatment with negative pressure results in high rates of delayed primary fascia closure. OA therapy with the technical modifications described is thus considered a suitable treatment option in various abdominal emergencies.     

Mesh-augmented versus direct abdominal closure in patients undergoing open abdomen treatment

Background

Open abdomen (OA) may be required in patients with abdominal trauma, sepsis or compartment syndrome. Vacuum-assisted wound closure and mesh-mediated fascial traction (VAWCM) is a widely used approach for temporary abdominal closure to close the abdominal wall. However, this method is associated with a high incidence of re-operations in short term and late sequelae such as incisional hernia. The current study aims to compare the results of surgical strategies of OA with versus without permanent mesh augmentation.

Methods

Patients with OA treatment undergoing vacuum-assisted wound closure and an intraperitoneal onlay mesh (VAC-IPOM) implantation were compared to VAWCM with direct fascial closure which represents the current standard of care. Outcomes of patients from two tertiary referral centers that performed the different strategies for abdominal closure after OA treatment were compared in univariate and multivariate regression analysis.

Results

A total of 139 patients were included in the study. Of these, 50 (36.0%) patients underwent VAC-IPOM and 89 (64.0%) patients VAWCM. VAC-IPOM was associated with reduced re-operations (adjusted incidence risk ratio 0.48 per 10-person days; CI 95%?=?0.39–0.58, p?<?0.001), reduced duration of stay on intensive care unit (ICU) [adjusted hazard ratio (aHR) 0.53; CI 95%?=?0.36–0.79, p?=?0.002] and reduced hospital stay (aHR 0.61; CI 95%?=?0.040–0.94; p?=?0.024). In-hospital mortality [22.5 vs 18.0%, risk difference ??4.5; confidence interval (CI) 95%?=???18.2 to 9.3; p?=?0.665] and the incidence of intestinal fistula (18.0 vs 22.0%, risk difference 4.0; CI 95%?=??10.0 to 18.0; p?=?0.656) did not differ between the two groups. In Kaplan–Meier analysis, hernia-free survival was significantly increased after VAC-IPOM (p?=?0.041).

Conclusions

In patients undergoing OA treatment, intraperitoneal mesh augmentation is associated with a significantly decreased number of re-operations, duration of hospital and ICU stay and incidence of incisional hernias when compared to VAWCM.

     

EHS clinical guidelines on the management of the abdominal wall in the context of the open or burst abdomen

Purpose

To provide guidelines for all surgical specialists who deal with the open abdomen (OA) or the burst abdomen (BA) in adult patients both on the methods used to close the musculofascial layers of the abdominal wall, and regarding possible materials to be used.

Methods

The guidelines were developed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach including publications up to January 2017. When RCTs were available, outcomes of interest were quantitatively synthesized by means of a conventional meta-analysis. When only observational studies were available, a meta-analysis of proportions was done. The guidelines were written using the AGREE II instrument.

Results

For many of the Key Questions that were researched, there were no high quality studies available. While some strong recommendations could be made according to GRADE, the guidelines also contain good practice statements and clinical expertise guidance which are distinct from recommendations that have been formally categorized using GRADE.

Recommendations

When considering the OA, dynamic closure techniques should be prioritized over the use of static closure techniques (strong recommendation). However, for techniques including suture closure, mesh reinforcement, component separation techniques and skin grafting, only clinical expertise guidance was provided. Considering the BA, a clinical expertise guidance statement was advised for dynamic closure techniques. Additionally, a clinical expertise guidance statement concerning suture closure and a good practice statement concerning mesh reinforcement during fascial closure were proposed. The role of advanced techniques such as component separation or relaxing incisions is questioned. In addition, the role of the abdominal girdle seems limited to very selected patients.

     

Algorithm for the management of large abdominal wall defects due to laparostomy wounds following intra-abdominal catastrophe

Background

Abdominal reconstruction of large defects is a challenge, and there is an additional morbidity and mortality when it is associated with emergency laparotomy or laparostomy. This study describes the surgical management of abdominal defects and describes an algorithm for complex abdominal reconstruction. We assessed complications such as fistula formation and the development of incisional hernias following formalised introduction of laparostomy for the management of these emergency patients.

Methods

A retrospective case review of 89 patients who underwent emergency laparotomy with laparostomy formation between January 2007 and March 2009 in our hospital was carried out.

Results

During the 27-month study period, 89 patients (33 females, median age 60, range 12–86) underwent emergency laparotomy and formation of laparostomy. Thirty-one patients (35 %) died. Failure of laparostomy closure was inversely related to death (p?=?0.001). Thirty of 58 patients who survived (52 %) had their laparostomy closed prior to discharge from intensive care (mean 4 days, range 1–7). Of the 28 patients who did not have their laparostomy closed prior to discharge from intensive care, 13 subsequently underwent abdominal reconstruction using Vicryl® mesh and primary closure as there was minimal tension to close the abdomen. The remaining 15 patients had tension at the wound edge and so underwent a two-stage abdominal reconstruction by initial skin grafting followed by active abdominal wall reconstruction using a modified component separation technique. No dermal substitutes were required.

Conclusions

The aim of a tension-free closure was achieved using a one- or two-stage abdominal reconstruction algorithm. A lateral release of fascia avoids the need for artificial dermal substitutes and can be used in the presence of a stoma. Multidisciplinary team decision making improves primary fascial closure rate and minimises the risk of enterocutaneous fistulae and incisional hernia formation. Level of Evidence: Level IV, therapeutic study     

Open abdomen and entero-atmospheric fistulae: An interim analysis from the International Register of Open Abdomen (IROA)

Introduction

No definitive data describing associations between cases of Open Abdomen (OA) and Entero-atmospheric fistulae (EAF) exist. The World Society of Emergency Surgery (WSES) and the Panamerican Trauma Society (PTS) thus analyzed the International Register of Open Abdomen (IROA) to assess this question.

The use of vacuum assisted closure therapy in the management of Fournier's gangrene

Background

Vacuum Assisted Closure (VAC; Kinetic Concepts, Inc., San Antonio, TX) has been used to successfully treat a variety of complex wounds. This technique was investigated for use in managing Fournier's gangrene following initial debridement.

Methods

Ten patients with Fournier's gangrene were treated in this study. After initial surgical debridement, 5 were treated using conventional therapy and 5 were treated with VAC at each dressing change. The effectiveness and cost of VAC for this indication were assessed; patient and physician satisfaction were also determined.

Results

Conventional and VAC treatment were equally effective in healing the wounds. The total costs of each treatment were similar. With the use of VAC, patients had fewer dressing changes, less pain, fewer skipped meals, and greater mobility. Hands-on treatment time was decreased for physicians using VAC.

Conclusions

VAC therapy is an effective and economical way to manage Fournier's gangrene. Patients and physicians were more satisfied with VAC therapy than with conventional treatment.     

Vacuum-assisted closure for wound management in the pediatric population

Background/Purpose

Wound management in children has traditionally consisted of daily dressings. Although vacuum-assisted closure (VAC) is well described in the adult literature, there are few reports about children. We reviewed our experience with VAC.

Methods

A retrospective review from 2003 to 2005 revealed that 16 children underwent VAC. Variables analyzed included demographics, diagnosis, duration and characteristics of VAC, wound closure, recurrence, complications, and cost analysis.

Results

Sixteen children received VAC therapy at an average age of 12.1 years (range, 1 month-18 years). Indications included tissue loss after pilonidal sinus excision (n = 8, primary = 5, recurrent = 3) after wound dehiscence of the abdomen (3), the sternum (2), the back (1), the leg (1), and after chronic postoperative perineal fistula. Average length of VAC use was 23 days, with an average pressure of 104 mm Hg. Wound closure occurred in 15 of 16 patients. Patients with primary pilonidal disease obtained wound closure by 45 days, whereas those with recurrent disease required 72 days. Children with wound dehiscence healed by 28 days. Recurrent sinuses developed in all 3 patients with known recurrent pilonidal disease. Pain in 1 patient required cessation of VAC therapy after 7 days. Follow-up after wound closure averaged 8 months.

Conclusions

Vacuum-assisted closure is well tolerated in our pediatric population and offers many advantages including fewer dressing changes and an earlier return to daily activities.