Date of Graduation

2008

Degree Type

Capstone Project

Degree Name

Master of Science in Physician Assistant Studies

First Advisor

Mark Pedemonte MD

Second Advisor

Jonathon W Gietzen MS PA-C

Abstract

Introduction: Negative Pressure Wound Therapy (NPWT) is used extensively in the acute and chronic wound care arena of health care. It has become a standard of care for many types of wounds from non-healing diabetic foot ulcers and burns to traumatic and surgical wounds. Recently attention has been paid to using this system for the treatment of catastrophic abdominal wounds.

Purpose: This literature review will examine the question of the effectiveness of Negative Pressure Wound Therapy in the treatment of open abdomen as a consequence of trauma or surgery. This is an important consideration as the use of damage control laparotomy continues to gain popularity among trauma surgeons more and more patients will be treated with this technique. A clear understanding of the current literature can lead to the formation of concise and practical guidelines which can be used in the application of this technique for the benefit of patients.

Methods: The literature considered for this study met certain requirements. They should have been English language studies published in the last 10 years. They had to study an aspect of application of Negative Pressure Wound Therapy to an abdominal wound whether as a result of trauma or surgery. Consensus statements and other summery articles were excluded from this review. This literature was obtained through an exhaustive search of Medline, PUBMED, MD Consult, and Up-to-date Online. Although efforts were made to find literature published in the last 2 years articles from 1998 to the present were considered for review. To reduce the potential introduction of bias a concerted effort was made to find studies and observations by entities not affiliated with KCI, Inc.

Results: There is agreement among these authors that Negative Pressure Wound Therapy is effective in the treatment of open abdominal wounds in the setting of both surgery and trauma. There was a noted an increased formation of granulation in the wounds as well as possible improvement in control and quantification of wound fluid output. NPWT is a useful adjunct in the setting abdominal compartment syndrome as a means of control of intra-abdominal pressures. Decreases were noted in morbidity rates and complications due to the open abdomen. NPWT is effective in the treatment and prevention of the post-operative complications of enterocutaneous fistulae, abdominal wound dehiscence, and ventral hernia.

Conclusion: Taken as a whole the literature presented above shows compelling reasons include Negative Pressure Wound Therapy in the armamentarium of treatments used for the resolution of open abdominal wounds and their potential consequences, most notably enterocutaneous fistulae and abdominal wound dehiscence, in the settings of trauma, massive resuscitation, prior abdominal surgeries, and infection

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