Provisional Negative Pressure Dressing Provides Abdominal Closure

A new study describes how a negative-pressure wound therapy (NPWT) system assembled from readily available medical-surgical supplies can provide temporary abdominal closure in remote settings.

Developed by researchers at the University of California Davis Medical Center (UCDMC; Sacramento, CA, USA) and Derriford Hospital (Plymouth, United Kingdom), the system requires a sterile bowel bag, sterile gauze swabs, a 32-F chest tube, a Heimlich valve, and an occlusive adhesive dressing to cover the abdomen. The bowel bag is placed around the intra-abdominal contents and surrounded by large laparotomy packs, and the chest tube is placed onto the packs and covered with a surgical towel or additional surgical gauze.

After the wound is sealed with the occlusive dressing, the Heimlich valve is attached to the exposed end of the chest drain to allow formation of negative intra-abdominal pressure, which the valve maintains, obviating the need to maintain continuous suction after application. Suction can be reapplied as needed if pressure fails, the dressing appears soaked, or continuous suction becomes available. According to the researchers, the technique has applications for military surgeons, as well as in humanitarian settings where the logistic supply chain may be fragile. The study was published on September 12, 2018, in the Journal of the Royal Army Medical Corps.

“This method of temporary abdominal closure provides the benefits of negative pressure temporary abdominal closure after damage control surgery, without the need for continuous suction or specialized equipment,” concluded senior author vascular surgeon Edwin Faulconer, MD, of Derriford Hospital, and colleagues. “The main downsides include the need to monitor the dressing off suction, the need for suction if there is a large amount of intraperitoneal fluid, and maintaining a seal in complex penetrating injury patterns.”

NPWT is a therapeutic technique used to promote healing in acute or chronic wounds and enhance healing of first and second-degree burns. The therapy involves the controlled application of sub-atmospheric pressure to the local wound environment, using a sealed wound dressing connected to a vacuum pump. The use of this technique in wound management increased dramatically over the 1990s and 2000s.

Related Links:
University of California Davis Medical Center
Derriford Hospital