Hwa-Tsung Chena, b, Li-Fu Chenga, b
a Department of Surgery, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
b School of Medicine, Tzu Chi University, Hualien, Taiwan
Abstract
This report discusses the successful management of two complex open abdominal wounds. The wounds were temporarily closed with a silastic sheet. After several dressing changes with vacuum-assisted closure (VAC), bilateral bipedicle advancement flaps were used to close the complex open abdominal wound. Case 1: a 41-year-old man underwent gastric bypass surgery for morbid obesity. Wound dehiscence resulted from a sudden increase in intra-abdominal pressure while weaning from mechanical ventilation. The huge open wound was temporarily covered with a silastic sheet. After serial VAC dressing changes, the wound was progressively reduced. The defect was completely repaired using bilateral bipedicle advancement flaps. The skin defects in the lateral abdominal wall were then covered with a split-thickness skin graft. Case 2: a 65-year-old woman underwent emergency surgery for hypovolemic shock from active upper gastrointestinal bleeding. She had a history of three biliary operations for intrahepatic and common bile duct stones. Hemobilia caused by a ruptured intrahepatic pseudoaneurysm was controlled by intraoperative arterial embolization. To prevent abdominal compartment syndrome, the open wound was initially covered with a silastic sheet. The wound was progressively reduced by serial VAC dressing changes. The midline wound was then successfully closed by bilateral bipedicle advancement flaps. After VAC dressing, the skin defects in the lateral abdominal wall were directly closed 2 weeks later. In our experience, a combination of VAC and bilateral bipedicle advancement flaps is effective for the definitive fascia to fascia closure of huge complex open abdominal wounds.
Keywords
Abdominal compartment syndrome; Bilateral bipedicle advancement flaps; Open abdomen; Vacuum-assisted closure
