Temporary Closure of the Open Abdomen: A Systematic Review on Delayed Primary Fascial Closure in Patients with an Open Abdomen

Background This study was designed to systematically review the literature to assess which temporary abdominal closure (TAC) technique is associated with the highest delayed primary fascial closure (FC) rate. In some cases of abdominal trauma or infection, edema or packing precludes fascial closure after laparotomy. This "open abdomen'' must then be temporarily closed. However, the FC rate varies between techniques. Methods The Cochrane Register of Controlled Trials, MEDLINE, and EMBASE databases were searched until December 2007. References were checked for additional studies. Search criteria included (synonyms of) "open abdomen,'' "fascial closure,'' "vacuum,'' "reapproximation,'' and "ventral hernia.'' Open abdomen was defined as "the inability to close the abdominal fascia after laparotomy.'' Two reviewers independently extracted data from original articles by using a predefined checklist. Results The search identified 154 abstracts of which 96 were considered relevant. No comparative studies were identified. After reading them, 51 articles, including 57 case series were included. The techniques described were vacuum-assisted closure (VAC; 8 series), vacuum pack (15 series), artificial burr (4 series), Mesh/sheet (16 series), zipper (7 series), silo (3 series), skin closure (2 series), dynamic retention sutures (DRS), and loose packing (1 series each). The highest FC rates were seen in the artificial burr (90%), DRS (85%), and VAC (60%). The lowest mortality rates were seen in the artificial burr (17%), VAC (18%), and DRS (23%). Conclusions These results suggest that the artificial burr and the VAC are associated with the highest FC rates and the lowest mortality rate

Pre- and post-germination determinants of spatial variation in recruitment in the perennial herb Helleborus foetidus L. (Ranunculaceae)

1 Recruitment in plant populations is a multiphase sequential process. An integrated view of the relationships between the stages and processes involved is therefore needed, but few studies have analysed the direct and indirect effects concerned. We propose a causal model of these relationships and use structural equation modelling (SEM) and path analysis to investigate the direct and indirect effects of pre- and post-germination processes on recruitment. 2 We collected information on seed production, pre-dispersal seed losses, seed removal from the ground, seedling emergence and mortality, and seedling recruitment during the first year after emergence from 1 × 1 m plots centred on reproductive individuals in three geographically distant populations of the perennial herb Helleborus foetidus. 3 The results suggest some congruence between the three populations and indicate that post-germination processes shape the spatial variation in recruitment more than pre-germination processes. Although between-plot variation in recruitment was mostly explained by seedling emergence and mortality, factors such as seed production and removal still have significant effects on recruitment through various, and frequently contrasting, pathways. 4 Path analysis is a powerful analytical tool for revealing important aspects of the recruitment dynamics of plant populations and the factors determining their spatial variation. Such aspects, including indirect effects, are difficult to quantify with other, more classical, approaches to recruitmentPeer reviewe