The wittmann patch s a temporary abdominal closure device. The term open abdomen refers to a surgically created defect in the abdominal wall that exposes abdominal viscera. Survivors subsequently underwent primary abdominal closure, with no. The indications for open abdomen oa are generally all those situations in which is ongoing the development an intraabdominal hypertension condition iah, in order to prevent the development of abdominal compartmental syndrome acs. The wittmann patch is a velcro like device for bridging and reapproximating abdominal wall openings where primary closure is not possible andor repeat abdominal entries are necessary the wittmann patch is often used with open abdomen negative pressure treatment when negative pressure treatment alone isnt enough to achieve fasciatofascia closure. The wittmann patch s a temporary abdominal closure device after decompressive celiotomy for abdominal compartment syndrome following burn.
Temporary abdominal closure with a bridged biologic mesh or synthetic system e. Temporary abdominal closure options include the wittmann patch, bogota bag, vacuumassisted closure vac, the abthera device, and synthetic or biologic mesh. The following photos illustrate the wittmann patch application as described in the use instructions and in the clinical literature by surgeons using it together with an adhesion preventing barrier the wittmann patch is also added to negative pressure dressing systems when these systems alone are not enough to achieve fascial closure. In addition, the closure should be efficient, performed without tension or ischemia, comfortable for the patient, and aesthetic. Abdominal compartment syndrome after revar endovascular. If the surgeon places the patch without abdominal exploration, you should look instead to an appropriate integumentary system closure code for instance, 160, secondary closure of surgical wound or dehiscence, extensive or complicated, with modifier 58 appended.
Passive vcds enhance hemostasis with prothrombotic material or mechanical compression, but do not achieve prompt hemostasis or. In 16 survivors who had the wittmann patch placed to facilitate abdominal closure, 15 patients 94% had their fascial closed after removal of the patch. Accessgudid wittmann patch 00810805000187 for temporary bridging of abdominal wall openings where primary closure is not possible andor repeat abdominal entries are necessary. Wittmann retired from the medical college but continued his work on devices related staged abdominal repair and temporary abdominal closure devices. For this reason, this method enjoys popularity and it results in good overall outcomes. Critically ill surgical patients frequently develop intraabdominal hypertension iah leading to abdominal compartment syndrome acs with subsequent high mortality. Open abdomen in trauma and emergency general surgery. Frontiers prevention of incisional hernias after open.
Abdominal compartment syndrome, damage control surgery in traumatology, diffuse peritonitis and wound dehiscence are the most common indications for applying the open abdomen oa treatment concept. One of the initial references of the use of open abdomen technique was by ogilvie in 1940 during world war ii. Patients managed by open abdomen from 2001 through 2006 were identified from the trauma. Review of vascular closure devices cath lab digest. While the vac system is automated, it does not supply sufficient closure force to quickly resolve. Options for closure of the infected abdomen europe pmc. Vacuumassisted closure device enhances recovery of. Starsurgical will exchange any counterfeit product for the genuine wittmann patch quickly and at no cost. The patients were treated with decompressive celiotomy and wittmann patch closure.
The wittmann patch starsurgical, burlington, wi, an arti. Management of the tense abdomen or difficult abdominal closure after operation for ruptured abdominal aortic. Like the predicate devices the wittmann patch is adjustable fascial expander prosthesis. There are several devices out on the market that address the need for gradual, yet as quick as possible, abdominal closure. It consists of a sterile hook and a sterile loop sheet made from propylene and nylon. It is a device that consists of two adherent velcro sheets, one consisting of loops and the other of hooks.
The wittmann patch is a hook and loop abdominal closure tool that is indicated for temporary bridging of abdominal wall openings where primary closure is not possible andor repeat abdominal entries are necessary. At this point, temporary abdominal closure was performed using the abra in combination with the v. Keramati m1, srivastava a, sakabu s, rumbolo p, smock m, pollack j, troop b. Use of topical negative pressure in assisted abdominal closure does not lead to high incidence of enteric fistulae published online april 28, 2009. Devices for wound closure surgical wound closure wound. The wittmann patch as a temporary abdominal closure. Dietmar wittmann academic dictionaries and encyclopedias.
Change of vac dressing thank you for any help or ideas you can share. The rate of primary closure for the wittmann patch ranges from 78 to 100%. Other advantages of the wittmann patch technique include a gradual approximation of fascia, ease of reexploration, and prevention of loss of abdominal domain. Wittmann was born on june 16, 1940 in duisburg, germany. The use of the wittmann patch facilitates a high rate of. After 21 days with the abra, definitive abdominal closure was achieved. The open abdomen oa is a planned management strategy implemented in critically injured patientsthatneed relaparotomy to complete definitive surgery. The ideal abdominal wound closure provides strength and a barrier to infection.
Diagnosis of abdominal compartment syndrome was based on elevated bladder pressure and organ dysfunction. Fascial closure immediately after definitive repair of injuries was defined as early fascial closure. This giant ventral hernia may then be dealt with using various reconstructive techniques after a long. Although beneficial in certain patients, the act of keeping an abdominal cavity open has physiologic. However, the incidence of incisional hernias, although much more controlled than when leaving an abdomen open, is high and reaches up to 65%. The wittmann patch starsurgical, burlington, wi, an artificial burr velcrolike device that is sutured to the abdominal fascia, when used to manage an open abdomen has been shown to facilitates dafc with a success rate 80% in a group of mixed trauma and abdominal sepsis patients. He started the surgical critical care fellowship program at the medical college of wisconsin in 1990 and became its first director. It is well known that temporary abdominal closure tac devices provide the augmented drainage of mediatorrich peritoneal fluid. Temporary abdominal closure is a critical treatment modality in select abdominal surgery patients. I am not sure how to code the patch thank you for any help you can provide. A bogota bag is a sterile plastic bag used for closure of abdominal wounds. Since april 2004, the wittmann patch was uniformly employed in open abdomen management. The wittmann patch starsurgical, burlington, wi is a unique device which uses velcro to permit progressive abdominal closure without necessitating serial operations. The use of the wittmann patch facilitates a high rate of fascial closure in severely injured trauma patients and critically iii emergency surgery patients.
A dodge that has twice helped me in a difficulty is the use of. The use of temporary abdominal closure devices is nowadays the gold standard to have the highest closure rates with meshmediated fascial traction as the proposed standard of care. Patients managed before the use of this device prepatch were compared with those managed in the patch era. Good morning, i have a patient that has been taken back to the or for reopening of exlap with placement of a wittmann patch and wound vac change for open abdominal wound. Wittmann patch medical billing and coding forum aapc. In fact all those involved in care of a critically ill patient should in the first instance think how to prevent iah and acs. Techniques for abdominal wall closure after damage control. Wittmann patch adjustable abdominal closure the wittmann patch is an adjustable hookandloop fascial closure tool for. Leaving an abdominal cavity temporarily open has been well described for several indications, including damage control surgery and abdominal compartment syndrome. Although this technique can be lifesaving and morbidity reducing, it is also associated with specific risks. Continuation of the open abdomen beyond the definitive repair of injuries with subsequent fascial closure was defined as delayed fascial closure.
The management of catastrophic abdominal injuries has been described in past military conflicts. The requirements for the ideal temporary abdominal closure tac are numerous and include the following. Aggressive resuscitation combined with staged surgery in severely injured patients has increased the incidence of abdominal compartment syndrome acs leading to the development ofopen abdomen strategy oa. Since mid 2004, we have incorporated wittmann patch staged abdominal closure into our management of the open abdomen.
Wound closure devices include specially designed sutures, staples and mechanical apparatus that aid in closing wounds by manipulating edges of the wound tissue closer together. Exp lap with placement of the wittmann patch i can use 4900258 2. Suturing of artificial burr ie, velcro to fascia, staged abdominal closure by application of controlled tension. These include dynamic retention sutures drs, the wittmann patch, and the vacuum assisted wound closure vac system.
The authors considered that the wittmann patch provided a simple method to accommodate the change in abdominal girth and it has not been associated with spontaneous opening. The wittmann patch is a temporary abdominal fascia prosthesis for the planned open abdomen to ease management of cases where the abdomen cannot be closed due to abdominal compartment syndrome or because multiple further operations are planned damage control repair dcr. We compared two temporary abdominal closure systems bogota bag and vacuumassisted closure vac device in intraabdominal pressure iap control. Surgical approach to peritonitis and abdominal sepsis. The purpose of this study was to determine the fascial closure rate using the wittmann patch. The wittmann patch as a temporary abdominal closure device after decompressive celiotomy for abdominal compartment syndrome.
We hypothesized that use of the patch would result in a high closure rate. The submitted article entitled the wittmann patch as a temporary abdominal closure device after decompressive celiotomy for abdominal compartment syndrome following burn and its associated figures is an original manuscript which has not been previously published elsewhere and is not under consideration for publication by another editor. Biological mesh combined with topical negative pressure. Despite the advances in new technological support and improvement of different available devices for the treatment of caws. The use of these two devices together may lead to a higher incidence of fasciatofascia abdominal wall closure than the use of fascial tension alone. The purpose of this study was to evaluate the impact of this device on our incidence of fascial closure versus planned ventral hernia. He is the inventor of a fascia prosthesis for temporary abdominal closure, the artificial bur fascia prosthesis generic or wittmann patch and star patch trade names. Vascular closure devices vcds were introduced in the early 1990s with the goal of limiting the time, labor, bed rest and patient discomfort associated with mc. We attempted to close the abdomen using a wittmann patch, but failed because of necrosis of the abdominal wall. Wound closure devices vary in design and may require tensionpressure adjustment once applied to a patient, or absorb into the skin, depending on the function and manufacture. Starsurgicals wittmann patch trademark by a decision dated 10 july 2014. Advancement of the patch basically pulling it tighter 3.
This prospective study with a historical control included 66 patients. Survivors subsequently underwent primary abdominal closure, with no evidence of ventral hernia at longterm followup. Allows for easy reexploration and eventual primary fascial closure. They compared 37 patients who had temporary abdominal closure with a commercial. The open abdomen, indications, management and definitive. The wittmann patch is a type of temporary abdominal closure that is used to incrementally close an open abdomen.
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