Open Abdomen Management With Human Acellular Dermal Matrix in Liver Transplant Recipients
Department of Hepato-biliary and Liver Transplant, Westchester Medical Center, Valhalla, New York 10595, USA. Transplantation Proceedings
(Impact Factor: 0.98).
01/2009; 40(10):3541-4. DOI: 10.1016/j.transproceed.2008.06.105
Abdominal wall closure after liver transplantation is not always feasible and may result in increased intra-abdominal pressure along with associated complications. Various temporary closure techniques as well as open wound management have been used to address this complex problem. The aim of this series was to describe an approach to definitive wound closure of the open abdomen in liver transplant patients.
We performed a retrospective review of all liver transplant patients at our institution from September 2005 to November 2007. The management of the open abdomen in 10 liver transplant patients was reviewed, and a novel approach described to manage these defects.
Ten patients with open wounds were closed during the study period using human acellular dermal matrix (HADM). There were 7 men and 3 women of median age 55 years. Average size of HADM was 235 cm(2). The median follow-up is 10 months with no incidence of evisceration or hernia. In 1 patient, the graft failed along the lateral side due to infection; it dislodged during vacuum-assisted closure dressing change in another patient at 5 months after closure. Fascial closure was not possible due to organ edema (n = 3), a large liver (n = 4) or wound infection with dehiscence (n = 3).
HADM can be used for primary wound closure in both clean and contaminated wounds as an alternative to an open abdomen post-liver transplantation.
Available from: Dan Cullinane
- "Facial closure rates ϭ 70%. Patients closed with VAC system had similar quality of physical and mental health scores at 3 months compared to " controls " Hadeed et al. 2007 III 24 The rate of closure using the Wittmann patch is equivalent to other commonly used methods Kushimoto et al. 2007 III 11 Bilateral anterior rectus sheath turnover flaps may be useful for definitive closure of the open abdomen that is not amenable to delayed primary fascial closure, particularly if the defect is less than 15 cm at greatest width Petersson et al. 2007 III 7 Vacuum-assisted delayed primary fascial closure can be effective with dynamic serial tensioning of meshmediated fascial traction Gaddnas et al. 2007 III 11 Continuous retention suture may be helpful in achieving delayed primary fascial closure through dynamic serial tension Defranzo et al. 2008 III 37 VAC-assisted closure may facilitate delayed primary fascial closure and simplify abdominal wall reconstruction with low morbidity Vertrees et al. 2008 III 85 Complex open abdominal wounds have lower delayed primary fascial closure rates and are more likely to require biologic or non-biologic prosthesis Singh et al. 2008 III 10 HADM provides for successful bridge in open abdomens both clean and infected fields with low complication rates Teixeira et al. 2008 II 900 The majority of damage control laparotomy abdomens can be closed primarily, which may substantially reduce development of enterocutaneous fistula. Deep space infection and intra-abdominal abscess are independently associated with failure to close the abdomen Tieu et al. 2008 III 29 Wittmann patch results in Ͼ80% rate of delayed fascial closure in trauma and EGS patients Wondberg et al. 2008 III 30 KCI vacuum-assisted closure of complex abdomen has worse outcomes compared to published closure rates trauma patients de Moya et al. 2008 II 10 HADM effectively closes/bridges complicated abdomen with low rate of fistula formation. "
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ABSTRACT: This research is concerned with a stability control method with a criterion based on reaction for motion control of a mobile manipulator. Mobile manipulators can propel themselves around a work area and can operate over a wide area. Then, a stability evaluation and a stability control method must be required for mobile manipulators that are not fixed on a floor. The evaluation method based on ZMP (Zero Moment Point) criterion, in which the model is regarded as a particle system, is not satisfactory for evaluating stability of a mobile manipulator that consists of solid links. In addition, transient state during tipping over has not been discussed. In this paper, we propose a stability evaluation criterion based on reaction for the solid model of a dynamic mobile manipulator. First, equations of motion of the mobile manipulator for stable and unstable states of motion are formulated based on constraint conditions. Second, a stability criterion based on reaction is proposed by referring the formulated model. Third, the relationships between changes in reaction and changes in ZMP during tipping over are discussed through simulations. Finally, it is shown that a mobile manipulator can return from unstable transient state to stable state by performing stability compensation motion.
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ABSTRACT: The open abdomen is a relatively new and increasingly common strategy for the management of abdominal emergencies in both trauma and general surgery. The use of an abbreviated laparotomy can reduce mortality associated with conditions such as abdominal compartment syndrome; however, the resulting open abdomen is a complex clinical problem. Modern techniques and technologies are now available that allow for improved management of the open abdomen and the progressive reduction of the fascial defect. Indeed, recent evidence indicates that a large proportion of patients treated with open abdomen can now be closed within the initial hospitalization. These techniques and technologies include the appropriate use of negative pressure therapy and synthetic or biologic repair materials. It is essential that general and trauma surgeons understand the core principles underlying the need for and management of the open abdomen. Toward this goal, an Open Abdomen Advisory Panel was established to identify core principles in the management of the open abdomen and to develop a set of recommendations based on the best available evidence. This review presents the principles and recommendations identified by the Open Abdomen Advisory Panel and provides brief case studies for the illustration of these concepts.
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