Original research
Systematic review and evidence based recommendations for the use of Negative Pressure Wound Therapy in the open abdomen

https://doi.org/10.1016/j.ijsu.2014.08.396Get rights and content
Under a Creative Commons license
open access

Highlights

  • NPWT is a widely adopted method of managing the OA but has a weak evidence base.

  • We present the first evidence-based recommendations to describe the use of NPWT in OA.

  • Recommendations divided by grade of open abdomen.

  • Published literature analysed to compare NPWT with other methods of TAC.

Abstract

Introduction: Negative Pressure Wound Therapy (NPWT) is widely used in the management of the open abdomen despite uncertainty regarding several aspects of usage. An expert panel was convened to develop evidence-based recommendations describing the use of NPWT in the open abdomen. Methods: A systematic review was carried out to investigate the efficacy of a range of Temporary Abdominal Closure methods including variants of NPWT. Evidence-based recommendations were developed by an International Expert Panel and graded according to the quality of supporting evidence. Results: Pooled results, in non-septic patients showed a 72% fascial closure rate following use of commercial NPWT kits in the open abdomen. This increased to 82% by the addition of a ‘dynamic’ closure method. Slightly lower rates were showed with use of Wittmann Patch (68%) and home-made NPWT (vac-pack) (58%). Patients with septic complications achieved a lower rate of fascial closure than non-septic patients but NPWT with dynamic closure remained the best option to achieve fascial closure. Mortality rates were consistent and seemed to be related to the underlying medical condition rather than being influenced by the choice of dressing, Treatment goals for open abdomen were defined prior to developing eleven specific evidence-based recommendations suitable for different stages and grades of open abdomen. Discussion and conclusion: The most efficient temporary abdominal closure techniques are NPWT kits with or without a dynamic closure procedure. Evidence-based recommendations will help to tailor its use in a complex treatment pathway for the individual patient.

Keywords

Negative Pressure Wound Therapy (NPWT)
Open abdomen
Temporary abdominal closure
Evidence-based recommendations
Systematic review

Cited by (0)