Negative pressure wound therapy (NPWT) is a valuable surgical technique in the management of a wide range of complex abdominal injuries and conditions including trauma, damage control, sepsis and relaparotomy. The present study aimed to identify the patients with abdominal sepsis and postoperative sepsis related conditions in which the NPWT would ensure the best results.
Methods
We reviewed the indications and the results of NPWT in patients with severe abdominal sepsis treated in our department from July 2015 to February 2017. We retrieve 19 patients with NPWT, 11 of them with secondary or tertiary peritonitis and the remaining 8 with postoperative fistula associated with peritonitis. We recorded the overall survival (OS), the ability to definitively close the abdomen, the length of hospital stay (LOS).
Results
There were 11 men and 8 women, with a mean age of 62.3 (35-74) years and a mean LOS of 43 days (14-101).The mean ASA score was 2.1. The mean number of vacuum dressings was 7, with a mean number of 5 for patients with peritonitis and 9 for those with postoperative complications. Abdominal closure using the mesh mediated fascial closure was achieved in 9 (47.3%) patients, while in one a double layer mesh had to be used. In another 7 (36,6%) patients abdominal closure was performed using split thickness skin grafts or direct suture of the overlaying skin with planned ventral hernia. In two patients abdominal closure could not be performed due to an important fistula output. The overall survival was 84.2%, while in hospital mortality was recorded only in three patients, all of them with postoperative fistulas and secondary organ failure.
Conclusion
NPWT improve overall outcome in abdominal sepsis. These results are clearly influenced by the etiology and patient status and seemed to be better when NPWT is associated immediately in the treatment of abdominal septic emergencies when compared to postoperative complications.
