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LINK Scientific Content – Congress Abstract

From craft systems to existing negative pressure systems

Scientific Content

From craft systems to existing negative pressure systems

Type
Congress Abstract
Topics
NPWT
Language
EN
Publication Year
2017
Author(s)
A. Oswaldo, G. Borráez

Summary

It is widely known the great efforts of surgeons over time to properly handle intra-abdominal infections. In 1.979 the Doctor Steimberg decided to manage the abdominal cavity as if it were an abscess, leaving it open, but he had the drawback that the evisceration was presented in his patients. In 1980 the Doctor Teichmann decided in these patients to cover the abdominal viscera with a mesh to which he added a zipper. In his patients he had better results but he had many intestinal lesions as much as the mesh as by the rack.

In 1984 at the San Juan de Dios hospital of the National University, in Bogotá, Colombia where I was a resident of General Surgery in a young patient with a closed abdominal trauma who required right hepatectomy and presented several complications, requiring reinterventions. In the fourth surgery I could not close it and because of the lack of resources I decided to leave the patient with the open abdomen covered with a plastic bag that I fixed to the fascia aponeurotic. This patient was practiced periodic drainage through the plastic bag. Way was born the so called Bogotá Bag or Borráez bag. For these patients we knew much better another pathology, such as abdominal hypertension. The same manner have existed intestinal fistulas. With the management of the open abdomen appeared other complications that we knew better: severe adherence syndrome, large herniated defects in the abdominal wall and the dreaded enteroatmospheric fistulas. In 1.994 two Orthopedicts, Doctors L. Argenta and M. Morykwas managing a patient with osteomyelitis developed a negative pressure system, which gave them excellent results: removed the infected material and purulent, in addition to allowing the granulation and healing of the tissues. This system of negative pressure called Vaccum assisted closure. This system in its beginnings was very expensive which forced many people to develop systems crafts. In the San Blas hospital in Bogotá, Colombia and in the year 1.995, I developed a negative pressure system with a vegetable product called scouring pad or scrubber (Luffa cylindrica). It is used for a body bathing. Why it is ?: because it has large holes and because of its consistency that makes it difficult to collapse. Thus allowed that when used the intestinal secretions derived from intestinal fistulas could pass through it and thus facilitate the organization and closure of intestinal fistula in 17 patients. In the world pharmaceutical industry has developed different negative pressure systems, making them simpler and easier to handle as well as reducing the cost.

We in recent years have been using the negative pressure system (Vivano) implemented by the Hartmann Group which is easy to handle and very economic. We have used it in some patients after passing the acute phase and has allowed us to contract the wound in such a way we can close it early without the use of mesh. We have also managed patients with intestinal fistulas, which have closed within 4 weeks. We have abandoned now the use of the systems of negative pressure crafts and we are using the system of negative pressure called Vivano. This system is very easy to use and it is comtemplated within the plan of health benefits in our country like others negative pressure system .

We continue to use the Bogotá Bag or Borráez Bag with some modifications introduced to the technique over the years, in different pathology, in order to reduce complications and facilitate the early closure of the abdominal wall without the use of meshes.

The indications in which we consider the use of the this system of the negative pressure are: in patients who require the technique of open abdominal management and could not be closed in the first week, but where has given way to the inflammatory aspect of the intestines and there is no greater risk of injuring the intestine by pressure and patients with abdominal trauma with intestinal and / or vascular lesions. These patients in the initial phase should be handled from my point of view with the Bogotá Bag or Borráez Bag and after the acute phase with the negative pressure system.

Authors

A. Oswaldo
National of Colombia University

G. Borráez
General Surgery, National of Colombia University

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