Vertical Mesh-Mediated Fascial Traction and Negative Pressure Wound Therapy: A Case Series of Nine Patients in General and Vascular Surgery.

Open abdomen (OA) is a well-established procedure for life-threatening illnesses such as septic peritonitis, abdominal compartment syndrome (ACS), and damage control surgery (DCS). Furthermore, in cases of life-saving aortic repair after perforation of abdominal aortic aneurysm, an OA is sometimes indicated. Definitive fascial closure (DFC) is one of the main goals during treatment to prevent further complications such as fistula formation and the development of an incisional hernia. In 2019, a new technique was introduced for OA using a device called fasciotens®Abdomen to apply dynamic traction to the abdominal wall through vertical mesh-mediated fascial traction (VMMFT). We present a case series including nine patients and show an algorithm for OA combining VMMFT and negative pressure wound therapy (NPWT). METHODS: Two patients in a vascular surgery unit and seven patients in an abdominal surgery unit with an OA were treated with VMMFT in combination with NPWT between September 2019 and June 2023. RESULTS: A DFC was achieved in seven of nine cases. The mean duration of OA was 9.6 ± 3.8 days, and fascial dehiscence at the beginning of OA was 14.2 ± 4.0 cm on average. Time to DFC after VMMFT was established was 6.2 ± 3.5 days (mean). No method-related complications occurred. CONCLUSION: The standardized combination of VMMFT and NPWT gave positive results in achieving DFC in our heterogenic patient group. Following a strict treatment pathway as shown here seems to improve OA outcome. It represents a promising further development of mesh-mediated fascial traction for OA treatment.

Vertical traction device prevents abdominal wall retraction and facilitates early primary fascial closure of septic and non-septic open abdomen.

PURPOSE: One of the major challenges in the management of patients with septic and non-septic open abdomen (OA) is to control abdominal wall retraction. The aim of this study was to evaluate the impact of a novel vertical traction device (VTD) on primary fascial closure (PFC) and prevention of fascial retraction. METHODS: Twenty patients treated with OA were included in this retrospective multicenter study. All patients were initially stabilized with laparostomy and the abdomen temporarily sealed either with a Bogotá bag or a negative pressure wound therapy system (NPWT). RESULTS: The mean duration of OA and fascia-to-fascia distance (FTF) prior to the VTD application were 3 days and 15 cm, respectively. At relook laparotomy 48 h after VTD implementation, the mean FTF distance significantly decreased to 10 cm (p = 0.0081). In all cases, PFC was achieved after a mean period of 7 days. Twelve patients received the VTD in combination with a NPWT, whereas in eight patients, the device was combined with an alternative temporary abdominal closure system (TAC). Although not statistically significant, the FTF distance remarkably decreased in both groups at relook laparotomy 48 h following the device implementation. The mean periods of PFC for patients with septic and non-septic OA were comparable (7.5 vs. 7 days). During follow-up, two patients developed an incisional hernia. CONCLUSION: Vertical traction device prevents fascial retraction and facilitates early PFC in OA. In combination with NPWT, rapid fascial closure of large abdominal defects can be achieved.

Regulation of Fas (APO-1, CD95) and Fas ligand expression in leukocytes during systemic inflammation in humans.

A potential role of Fas/FasL in sepsis is suggested by recent clinical studies showing that Fas and FasL could serve as markers for severity of sepsis. We sought to determine the effect of endotoxin infusion on expression of Fas and FasL. Healthy volunteers (n = 30) received 2 ng/kg endotoxin i.v. Endotoxin infusion decreased Fas expression on neutrophils and monocytes by 15-20% at 2-4 h in vivo and also in vitro. A rebound increase in Fas (30%) was seen on neutrophils at 24 h, and soluble FasL levels increased by 100% at 24 h. Fas mRNA levels increased 6-fold 4-6 h after endotoxin infusion as measured by real-time polymerase chain reaction. In contrast, FasL-mRNA levels in circulating leukocytes decreased by >80% 2h after lipopolysaccharide infusion. In summary, low-grade endotoxemia induces early down-modulation of Fas on leukocytes, followed by a several-fold increase in Fas-mRNA expression leading to later Fas surface upregulation on neutrophils. The upregulation of Fas expression, Fas mRNA, and later in FasL and sFas levels in endotoxemia replicates the increased fas levels found in septic patients.

Endotoxemia enhances expression of the signaling receptor (GP130) on protein and molecular level.

Interleukin 6 (IL-6) performs a prominent role during sepsis. To examine the molecular regulation of IL-6, IL-6 receptor, and signaling receptor gp130 during endotoxemia, nine healthy young volunteers received a bolus injection of lipopolysaccharide (LPS) on day 1 and saline on day 2 in a double blind, randomized, placebo-controlled trial. LPS enhanced IL-6 release 300-fold. IL-6 mRNA expression was not significantly altered in blood samples at any time after LPS infusion in vivo, while incubation of whole blood with 50 pg/ml LPS up-regulated IL-6 mRNA levels 8000- to 50,000-fold in vitro. LPS infusion increased synthesis of gp130 mRNA 5.5-fold compared to baseline at 4 h (P < 0.05), while no significant change was observed in the placebo period (P = 0.001 between groups). LPS increased the percentage of gp130 positive neutrophils gp130 700% over baseline at 8 h (P < 0.01 versus baseline and placebo). IL-6 receptor levels were not significantly altered by low-grade endotoxemia. In conclusion, endotoxemia up-regulates gp130 expression in vivo and in vitro. Quantification of IL-6 mRNA expression in circulating leukocytes is unlikely a suitable marker for monitoring of endotoxemia.