Post-surgical abdominal damage: Management and treatment with vacuum therapy and biological mesh

The "open abdomen" is a life-saving strategy in situations in which is ongoing the development an intra-abdominal hypertension condition (IAH), in order to prevent the development of abdominal compartmental syndrome. The aim of this paper is to describe a clinical case in association with a literature review concerning the use of vacuum therapy, biological mesh and skin graft, to treat open abdomen in a morbid obese patient with post-surgical abdominal damage. We report on the case of a 52-year-old obese male patient who presented in a state of septic shock, eventratio, respiratory failure, acute renal failure and necrosis of the abdominal wall, following bariatric surgery. We decided to menage the reconstruction of abdominal wall with negative-pressure wound therapy (NPWT) on a biological porcine mesh, in order to reduce wound dimensions over the implant and to prepare wound bed for a skin graft which was subsequently used to definitely close wound dehiscence. The biological mesh behaved like a scaffold for granulation tissue. The combination with NPWT stimulated an anti-infectious and neoangiogenesis-promoting environment, allowing a final closure with a split-thickness skin graft. In the case of large wound dehiscence, NPWT could be a therapeutic option, which has become standard of care in most centers. The combination with biological mesh seems to be a valid approach, allowing to postpone to a second operation the abdominal closure and avoid abdominal compartmental syndrome. The procedures seemed to combine perfectly together.