Reč specijalnog gosta, Prof Blaža Trotovšeka, UKC Ljubljana

Negative Pressure Wound Therapy

The knowledge that a tense abdomen is a life-threatening condition is very old. However, it was not until 1984 that the term ”abdominal compartment syndrome” (ACS) was suggested by Kron. Despite of increased understanding of ACS, clinicians often face the problem of managing a patient with an open abdomen (OA). The patient may reach OA situation through a number of clinical pathways. It is important to realize that the underlying pathophysiologic process is the same for sepsis or trauma and the only difference is the time line of the process. Managing the patient with an OA is still a great challenge even for an experienced clinician. The principal goals of management in OA situation are to prevent further deterioration and escalation of disease resulting in a more complex OA, to maintain the patient’s OA at the lowest and simplest grade and to facilitate primary delayed fascial closure as quickly as clinically appropriate.

For successful management of OA, temporary abdominal closure (TAC) is needed to protect the intestines, maintain a sterile or at least clean environment, and avoid fluid and temperature loss. Several techniques are available for TAC. Negative pressure therapy (NPWT) combined with abdominal dressing revolutionized advanced care of OA in last 15 years. High rate (>90%) of primary fascial closure, lower incidence of abscess and fistula formation, lower morbidity and mortality are the results of its more frequent use in treatment of OA. New foams have been developed (Abthera, KCI) in last years which are even more user-friendly and are improving our results in the management of OA.

In the last years modification of original NPWT system combined with installation has been introduced to clinical practice. Although intended for use in wounds it carries a great potential for other applications. Further studies will show its potential role even in the treatment of selected cases of OA especially grade 1b and 2b. In abdominal surgery we observed through the last three decades two major leaps in clinical practice: one of them was undoubtedly wide use of minimally invasive approaches in numerous procedures. This was recognition of ACS importance and revival of the OA strategy. OA in the last 30 years is not considered any more as a catastrophe or defeat of the surgeon but it represents a planned strategy which dramatically reduces mortality and morbidity in critically ill or injured patients. Development of modern TAC techniques was crucial for the change in attitude of many surgeons. KCI developed V.A.C abdominal dressing and later Abthera systems with attributes that approximate to the optimal demands for TAC system. Excellent results, simplicity of application and many other qualities makes them indispensable in everyday clinical practice.