Early repair of open abdomen with a tailored two-component mesh and conditioning vacuum packing: a safe alternative to the planned giant ventral hernia

Purpose Once open abdomen therapy has succeeded, the problem of closing the abdominal wall must be addressed. We present a new four-stage procedure involving the application of a two-component mesh and vacuum conditioning for abdominal wall closure of even large defects. The aim is to prevent the development of a giant ventral hernia and the eventual need for the repair of the abdominal wall. Methods Nineteen of 62 patients treated by open abdomen over a two-year period could not receive primary abdominal wall closure. To achieve closure in these patients, we applied the following four-stage procedure: stage 1: abdominal damage control and conditioning of the abdominal wall; stage 2: attachment of a tailored two-component mesh of polyglycolic acid (PGA) and large pore polypropylene (PP) in intraperitoneal position (IPOM) plus placement of a vacuum bandage; stage 3: vacuum therapy for 3–4 weeks to allow granulation of the mesh and optimization of dermatotraction; stage 4: final skin suture. During stage 3, eligible patients were weaned from respirator and mobilized. Results The abdominal wall gap in the 19 patients ranged in size from 240 cm2 to more than 900 cm2. An average of 3.44 vacuum dressing changes over 19 days were required to achieve 60–100 % granulation of the surface area, so final skin suture could be made. Already in stage 3, 14 patients (73.68 %) could be weaned from respirator an average of 6.78 days after placement of the two-component mesh; 6 patients (31.57 %) could be mobilized on the edge of the bed and/or to a bedside chair after an average of 13 days. No mesh-related hematomas, seromas, or intestinal fistulas were observed. Conclusion The four-stage procedure presented here is a viable option for achieving abdominal wall closure in patients treated with open abdomen, enabling us to avoid the development of planned giant ventral hernias. It has few complications and has the special advantage of allowing mobilization of the patients before final skin closure. Long-term course in a large number of patients must still confirm this result

Unklare, abdominelle Schmerzen nach Magenbypass - was tun, wenn die Routinediagnostik versagt?

Tovmo, M. & Mattisson, J. 2018. Yngleregistreringer av jerv i Norge i 2018. NINA Rapport 1553. Norsk institutt for naturforskning I år ble det påvist 57 dokumenterte eller antatte ynglinger av jerv i Norge. Dette er en øking i antall ynglinger på 42,5 % (17 flere ynglinger) i forhold til i fjor. Det nasjonale bestandsestimatet basert på antall ynglinger de tre siste årene viser at det i år er en bestand på rundt 307 voksendyr i Norge, noe som er en nedgang sammenlignet med 2017. Utviklingen av antall ynglinger i de ulike rovviltregionene viser at det er rovviltregionene 3 (Oppland), 5 (Hedmark) og 6 (Møre og Romsdal og Trøndelag) som har den største endringen i antall ynglinger sammenlignet med fjoråret. I regionene 5 og 6 er det en oppgang på hhv. sju og ti ynglinger sammenlignet med i fjor mens det er en nedgang på tre ynglinger i region 3. I regionene 7 (Nordland) og 8 (Troms og Finnmark) ble det registrert en oppgang på hhv. to og en yngling sammenlignet med i fjor. Alle rovviltregionene med fastsatt nasjonalt bestandsmål for regionen ligger på eller over bestandsmålet i forhold til gjennomsnittlig antall ynglinger av jerv de tre siste årene.Tovmo, M. & Mattisson, J. 2018. Yngleregistreringer av jerv i Norge i 2018. NINA Report 1553. Norwegian Institute for Nature Research A total of 57 wolverine reproductions were found in Norway in 2018. This is an increase of 17 reproductions (42.5%) compared to the previous year. The population estimate, based on the number of reproductions over the last three years, indicates a population around 307 adult animals. This is lower than in 2017. The most pronounced changes in the number of reproductions, compared to last year, were found in region 3 (Oppland), 5 (Hedmark) and 6 (Møre og Romsdal and Trøndelag). Region 5 and 6 had an increase of seven and ten reproductions respectively compared to the previous year while region 3 had a decrease of three reproductions. Regions 7 (Nordland) and 8 (Troms and Finnmark) had an increase of two and one reproduction respectively compared to the previous year. All carnivore regions with national population goals for wolverine reproductions have reached or exceeded these goals