DIY system provides negative-pressure temporary abdominal closure in remote settings

Last Updated: 2018-10-12

By Will Boggs MD

NEW YORK (Reuters Health) - A negative-pressure system assembled from readily available medical-surgical supplies can provide temporary abdominal closure without continuous suction in austere and remote settings.

"Negative-pressure laparostomy management of damage-control surgery was used in 75% of military cases in Bastion Hospital during the end of the recent Afghanistan conflict, and this trend is moving into non-military trauma setting," said Dr. Edwin Robert Faulconer from Derriford Hospital, in Plymouth, U.K.

"Establishing methods that are cost-effective, safe, do not rely heavily on advanced technology or complex logistics chains, and are easy to replicate is important for austere surgical management," he told Reuters Health by email. "We feel that our method achieves this aim for wound management after damage-control laparotomy and have described it so that it can be disseminated and studied further."

In a report online September 12 in the Journal of the Royal Army Medical Corps, Dr. Faulconer and colleagues describe a technique employed in a level 1 U.S. trauma center (University of California, Davis, Medical Center, in Sacramento) that would be reproducible and applicable in a military or humanitarian environment.

The system requires a sterile bowel bag, sterile gauze swabs, a 32-French chest tube, a Heimlich valve, and an occlusive adhesive dressing to cover the abdomen (Ioban).

The bowel bag is placed around the intra-abdominal contents and surrounded by large laparotomy packs, and the chest tube is placed onto the packs and covered with a surgical towel or additional surgical gauze. After the wound is sealed with the occlusive dressing, the Heimlich valve is attached to the exposed end of the chest drain to allow formation of negative intra-abdominal pressure, which the valve maintains.

Suction can be reapplied to the valve if pressure fails, the dressing appears soaked, or continuous suction becomes available.

"This approach, as with other negative-pressure wound-management dressings, relies on the ability to create and keep a seal," Dr. Faulconer said. "It is currently used off suction for short periods of time, but (we) hypothesize that this can be extended and, therefore, could be useful in austere surgical environments."

"The main downsides," he said, "include the need to monitor the dressing off suction, the need for suction if there is a large amount of intraperitoneal fluid, such as ascites, and maintaining a seal in complex penetrating injury patterns."

"We are continuing to refine and develop our ideas and will be aiming to study the effectiveness of the method in different scenarios to better advise surgeons in the future," Dr. Faulconer said.

Dr. Fabio Kamamoto from Faculdade de Medicina da Universidade de Sao Paulo, in Sao Paulo, Brazil, is a proponent of negative-pressure wound therapy (NPWT) who has also developed a low-cost system. He told Reuters Health by email, "In my opinion, this is a good option in an environment where the traditional NPWT is not available. It does not have the same effect, but it seems to be much better than a gauze dressing."

"I believe that physicians should understand that they do not need to limit their treatment even in difficult settings, and this article is a good example," he said. "There are plenty of options, and human creativity is bigger than the economic interest of the pharmaceutics industry."

SOURCE: https://bit.ly/2OfzTGC

J R Army Med Corps 2018.