Understanding How Fascial Movement Occurs Without Invasive Attachment

Open abdomen management presents a fundamental challenge: how to support early, effective primary fascial closure while minimizing additional tissue damage. Traditional approaches to fascial traction often rely on direct attachment of surgical material to the fascia or fascial edges, typically requiring sutures or invasive fixation. While these methods can generate localized force, they may also concentrate stress on specific suture points, limiting flexibility in ongoing management and potentially causing tissue damage.

AbClo introduces a different approach. Rather than relying on direct attachment to the fascia, it applies controlled, non-invasive traction across all layers of the abdominal wall to support progressive fascial reapproximation. Understanding this mechanism requires a shift in perspective—from localized force application to whole abdominal wall dynamics.

Why Traditional Fascial Traction Requires Attachment

Conventional traction systems are designed to reapproximate the fascia by applying force directly to the fascia. This is typically achieved through sutures or fixation devices that anchor traction to the fascia and pull it toward the midline.

While effective in generating tension, this approach presents several limitations:

• Force is concentrated at specific anchor points rather than distributed evenly.
• Tissue stress and complication risk may increase at sites of fixation because excessive pressure is created in a small area.
• The retraction force of the lateral abdominal wall musculature remains largely unaddressed.
• Adjustments may require further invasive procedures and return trips to the operating room rather than bedside modification, contributing to wound complications.

These factors can contribute to challenges in achieving timely and consistent fascial closure.

The Problem with Localized Force Application

Fascial retraction is influenced by the biomechanics of all layers of the abdominal wall. When the linea alba is disconnected at the midline during a laparotomy, lateral muscle groups exert unopposed lateral retraction.

When traction is applied only at the midline, it may not fully counteract these lateral forces. This imbalance contributes to rapid widening of the fascial defect, increased risk of fascial damage at the suture site, and potential fascial dehiscence following closure.

This highlights a key limitation of attachment-based pull systems: they invasively address the problem, creating additional disruption to the myofascial layers, rather than preventing the broader mechanical forces acting on the abdominal wall.

A Shift in Thinking: Whole Abdominal Wall Mechanics

AbClo’s mechanism of action is based on the principle that effective fascial closure requires engagement of the abdominal wall as a unified structure.

Rather than applying force directly to small suture points on the fascia, AbClo uses an external system to distribute force over a larger area, delivering circumferential, pressure-regulated traction across the entire abdominal wall. This allows force to be distributed more broadly across tissue layers, including skin, muscle, and fascia.

By engaging the lateral abdominal wall, AbClo’s approach helps counteract outward forces that contribute to loss of domain and supports more balanced medialization over time.

How AbClo Moves the Fascia Without Attachment

AbClo’s mechanism of action relies on two principles: compression and movement.

During application, the rectus muscle splints, placed approximately 5 cm from the fascial gap, are pushed downward and medially toward the midline. This compression force, explained by Young’s Modulus, increases the rigidity of the myofascial layers in the anterior abdominal wall, allowing force transfer to the fascial layer despite non-invasive placement on the skin.

The addition of tangential force—described by Shear Modulus mechanics—results in medialization across all layers of the abdominal wall.

This mechanism allows rapid re-establishment of abdominal wall integrity and pressure-controlled dynamic medial force without the need for sutures, pins, or direct fixation to the fascia.

Key characteristics of this mechanism include:

• Compression and Movement: Compression of the abdominal wall during application facilitates medial force transfer from the skin to the fascia.
• Distributed force application: Tension is applied across the abdominal wall rather than at isolated points.
• Engagement of lateral musculature: The AbClo system helps address unopposed forces that contribute to lateral retraction.
• Absence of direct fixation: Avoids localized pressure points on the fascia and limits downstream complications related to fascial damage, including wound complications and incisional hernias.
• Bedside adjustability: Tension can be modified progressively without requiring operative intervention.

The AbClo configuration supports a preventive approach to loss of domain with gradual reapproximation of the fascia while maintaining flexibility in patient management.

Dynamic Support and Progressive Reapproximation

The AbClo system may be understood as providing a form of continuous external support to the abdominal wall. Rather than applying static force, AbClo is pressure-regulated, allowing ongoing, adjustable tension over time.

This enables:

• Progressive reduction in fascial defect size without increasing abdominal compartment syndrome risk.
• Adaptation to changes in patient condition, such as edema or fluid shifts.
• Controlled advancement toward midline closure.

In a prospective pilot study, use of AbClo was associated with a statistically significant reduction in fascial defect size (p < 0.005) and higher rates of primary fascial closure compared to standard care with negative pressure wound therapy alone.¹

Clinical Evidence Supporting the Mechanism

Clinical outcomes provide further context for this mechanism:

• In the same pilot study, 85% of patients achieved primary fascial closure, compared to 55.6% in the control group, despite restrictions on device placement of 48 hours post-laparotomy.¹
• No device-related complications were reported, including fascial dehiscence.¹
• In the most recent AbClo closure study, the device helped achieve primary closure without mesh bridging in 98% of patients when the system was applied within 24 hours post-laparotomy.²
• When filtering for difficult patients who underwent two or more operative takebacks, placement of AbClo within the first 24 hours of open abdomen management resulted in a primary fascial closure rate of 93%.²

These findings suggest that non-invasive, distributed traction across the abdominal wall can support closure while avoiding some of the limitations associated with direct fixation methods.

Reframing Fascial Traction in Open Abdomen Management

AbClo’s mechanism of action reflects an evolution in how fascial closure can be approached in open abdomen management. Rather than focusing solely on attempts to reapproximate the fascia, it enables a preventive approach to lateralization using a non-invasive technology applied at the bedside.

By distributing force, engaging lateral structures, and allowing progressive adjustment, this approach supports a more controlled pathway toward closure—aligned with both biomechanical principles and current clinical priorities.

References

1. Rezende-Neto JB, Camilotti BG. New non-invasive device to promote primary closure of the fascia and prevent loss of domain in the open abdomen: a pilot study. Trauma Surgery & Acute Care Open. 2020;5(1):e000523. doi:10.1136/tsaco-2020-000523.

2. Naveed A, Martin ND, Bawazeer M, Jastaniah A, Rezende-Neto JB. Early placement of a non-invasive, pressure-regulated fascial reapproximation device improves reduction of the fascial gap in open abdomens: a retrospective cohort study. Trauma Surgery & Acute Care Open. 2024;9(1):e001529. doi:10.1136/tsaco-2024-001529.