Timely Closure of Open Abdomen Using Customized Two-Part Mesh and Vacuum Packing

Overview

A novel staged approach for managing large ventral hernias after open abdomen treatment involves a customized two-component mesh and vacuum packing. This method enables early patient mobilization and achieves low complication rates while facilitating abdominal wall closure in challenging cases.

Background

Open abdomen (laparostomy) is a widely used technique for managing abdominal trauma and secondary peritonitis, but prolonged open abdomen treatment complicates anatomic abdominal wall closure due to fascial retraction and inflammation. Traditional methods often result in giant ventral hernias requiring complex reconstruction. Biological meshes have limitations in septic environments, and staged closure using synthetic meshes combined with vacuum therapy offers a promising alternative. The staged therapy includes damage control, mesh fixation, vacuum conditioning, and skin closure to optimize outcomes.

Data Highlights

Key Findings

• Stage 1 focuses on damage control by managing intra-abdominal infection and pressure while conditioning the abdominal wall to prevent adhesions and allow later closure.
• Stage 2 involves suture fixation of a customized two-component mesh (PGA + PP) in an intraperitoneal onlay mesh (IPOM) position with transfascial sutures placed at 5-cm intervals.
• Vacuum therapy at 125 mmHg is applied over a polyurethane sponge to promote granulation and conditioning of the mesh and surrounding tissues (Stage 3).
• Stage 4 completes the procedure with skin closure over the granulated mesh, enabling early mobilization and reducing social limitations associated with giant ventral hernias.
• The two-component mesh combines absorbable PGA mesh to protect viscera and a durable PP mesh to provide reinforcement, overcoming limitations of biological meshes in septic environments.
• Use of an insulation bag during stage 1 protects bowel from adhesion and excessive vacuum pressure, facilitating safer vacuum-assisted closure.

Clinical Implications

This staged approach offers a viable option for patients with large ventral hernias following open abdomen treatment, especially when primary fascial closure is not possible. The combination of a customized two-part mesh and vacuum packing allows for effective abdominal wall reconstruction with low complication rates and supports early patient mobilization. Clinicians should consider this method in complex cases to improve functional and social outcomes.

Conclusion

The described staged procedure using a customized two-component mesh and vacuum therapy provides a practical and effective strategy for timely closure of open abdomen defects and management of large ventral hernias. It addresses the challenges of fascial retraction and infection while promoting early recovery.

References

1. Björck et al. 2016 -- Classification of open abdomen
2. Barker et al. 1995 -- Vacuum-assisted closure technique
3. Clinical experience with staged mesh closure and vacuum therapy