Platz, A.

Zingg, U.

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Treatment of the Open Abdomen with the CommerciallyAvailable Vacuum-Assisted Closure System in Patientswith Abdominal SepsisU. Zingg Æ A. PlatzPublished online: 4 March 2009 Socie´te´ Internationale de Chirurgie 2009We thank Dr. Perathoner and colleagues for their interest inour article [1]. The median time interval between the firstsurgery and the application of the vacuum-assisted closure(VAC) system was 7 (range, 0–17) days. In three patients,the VAC system was applied at time of the primary oper-ation, in 14 patients at time of the first revision (median,5 days after the primary surgery; range, 1–12 days), and in13 patients at time of the second revision (median, 11 daysafter primary surgery; range, 5–17 days). The primaryoutcome of our study was closure of the fascia, and we didnot evaluate or mention the time of use of subcutaneousVAC systems. We are convinced that the crucial steps oftreatment are mostly finished when the intra-abdominalsepsis is resolved and the fascia is closed or when an inlaymesh could be implanted. The treatment of the resultingsubcutaneous wounds was partially performed in an out-patient setting, and the time intervals would probably notreflect the fastest approach to complete wound closure.We agree with the observation of Perathoner et al. thatthe VAC system alone is insufficient to avoid fascialretraction. The concept of dynamic sutures as an adjuvantto avoid fascial retraction is interesting and needs furtherassessment in randomized trials. The use of additionalsutures on the fascial edges may have the disadvantage offurther reducing the quality of the fascia, especially inpatients who need multiple revisions. Therefore, in ourview, the most important factor to ensure primary closureis early, stepwise closure of the fascia.The VAC system has improved the treatment of patientswith abdominal sepsis and provides a safe treatment optionwith low system-related morbidity. However, as Perathonerand colleagues mentioned, there is a need for further trialswith larger cohort numbers and clear definitions onabdominal sepsis to evaluate the optimal use of the VACsystem in these critically ill patients.References1. Wondberg D, Larusson HJ, Metzger U et al (2008) Treatment ofthe open abdomen with the commercially available vacuum-assisted closure system in patients with abdominal sepsis: lowprimary closure rate. World J Surg 32:2724–2729U. Zingg  A. PlatzDepartment of Surgery, Triemli Hospital Zurich, Zurich 8063,SwitzerlandU. Zingg (&)Department of Surgery, University Hospital Basel,Spitalstrasse 21, 4031 Basel, Switzerlande-mail: uzingg@uhbs.chU. ZinggFlinders University Department of Surgery, Flinders MedicalCentre, Bedford Park, Adelaide 5042, SA, Australia123World J Surg (2009) 33:1334DOI 10.1007/s00268-009-9965-x

Treatment of the Open Abdomen with the Commercially Available Vacuum-Assisted Closure System in Patients with Abdominal Sepsis

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Treatment of the Open Abdomen with the Commercially Available Vacuum-Assisted Closure System in Patients with Abdominal Sepsis

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