Fluid volume overload negatively influences delayed primary facial closure in open abdomen management

J Surg Res. 2014 Mar;187(1):122-7. doi: 10.1016/j.jss.2013.09.032. Epub 2013 Sep 28.


Background and aim: The open abdomen (OA) is associated with significant morbidity and mortality, and its management poses a formidable challenge. Inability to achieve primary closure of the abdominal wall is one of the most severe complications of this technique. Factors influencing primary fascial closure, however, are unknown. This study aims to explore the influence of fluid volume overload on the application of vacuum-assisted and mesh-mediated fascial traction (VAWCM) in OA treatment.

Methods: A review of patients undergoing OA management using VAWCM technique from January 2006 to November 2011 was performed. Patients with aged <18 y OA treatment for fewer than 5 d and abdominal wall hernia before OA treatment were excluded.

Results: Average age was 45 ± 10.1 y and average OA treatment time was 31 ± 6.8 d. The complete fascial closure rate was 60%. The overall mean bodyweight-based fluid overload was 7.2 kg (range: -8.0 to +21.6 kg), representing a mean percent weight gain of 11.5% (range: -9.5% to +27%). Patients with fluid-related weight gain ≥10% had a lower primary facial closure rate than those with <10% (39% versus 77%). And primary facial closure rate seems to further decrease with fluid-related weight gain ≥20%, suggesting a dose-response effect of progressive fluid accumulation.

Conclusions: The VAWCM method provided a high primary fascial closure rate after long-term treatment of OA. Fluid volume overload negatively influences delayed primary facial closure. Judicious intravenous fluid resuscitation should be advocated in the therapy of critically ill patients.

Keywords: Delayed primary facial closure; Fluid volume overload; Open abdomen; Vacuum-assisted and mesh-mediated fascial traction.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Abdomen / surgery
  • Abdominal Wound Closure Techniques*
  • Adult
  • Fascia / physiology
  • Fasciotomy*
  • Female
  • Fluid Therapy / adverse effects*
  • Hernia, Ventral / mortality
  • Hernia, Ventral / surgery*
  • Humans
  • Male
  • Middle Aged
  • Negative-Pressure Wound Therapy*
  • Pancreatitis / mortality
  • Pancreatitis / surgery
  • Postoperative Complications / mortality
  • Postoperative Complications / physiopathology
  • Postoperative Complications / therapy
  • Retrospective Studies
  • Surgical Mesh
  • Water-Electrolyte Imbalance / complications*
  • Water-Electrolyte Imbalance / mortality
  • Wound Healing / physiology*