Recap of Blog Post #1
AbClo represents a significant advancement in the management of open abdomen cases. Regardless of the cause for the open abdomen approach, AbClo offers a safer and more efficient approach that simplifies complex surgical scenarios.
The distinct advantages of AbClo in advancing patient care and outcomes in open abdomen management:
Non-Invasive—being non-invasive, AbClo helps reduce additional surgical site incisions in the skin and fascia that are commonly found with other invasive traction devices.
Enhanced surgeons’ experience—AbClo simplifies complex cases, enabling faster closure without the need for biologic mesh or component separation. This reduces the need for additional surgical interventions, hence, less surgical strain and time in the OR.
Enhanced fascial reapproximation—the dynamic, pressure-regulated tension applied by AbClo maintains the integrity of the abdominal wall, minimizes muscle atrophy, prevents lateral fascial retraction, and reduces the likelihood of secondary complications.
Bedside application and management—AbClo makes patient management simpler and more efficient. Wound progression can be easily monitored by any trained staff, thereby accelerating recovery times.
Improved efficiency in care delivery—any trained authorized individual can apply/adjust/monitor the device, allowing surgical teams to focus more on patient care rather than struggling with technical difficulties in device handling.
Reduced Complication Rates—early primary fascial closure preserves normal abdominal physiology and reduces the risk of complications like entero-cutaneous fistulas or ventral hernias.
Better Outcomes—with a 98% primary fascial closure rate, AbClo outperforms current standards of care and surpasses those of competitor devices.
Improved Patient Experience—AbClo helps patients recover more quickly and healthily.
(Blog 2 of 3)
The “HOW” of AbClo
AbClo Principle
Unlike static devices, AbClo’s consistent dynamic therapeutic tension addresses the inertia required to gradually reduce the fascial defect and return fascial edges to the midline for definitive primary closure.
AbClo can safely be deployed to assist in primary closure in open abdomen (OA) patients and is indicated for use in all acute or trauma-based open abdomen (laparotomy) adult patients.
AbClo may be used alone or concurrently with negative pressure wound therapy (NPWT) such as AbThera.
Apply AbClo Early .. The Sooner the Better
Later fascial retraction occurs as early as one to two days1; the best results with the AbClo are obtained with early application.
AbClo Device Components and Placement
AbClo consists of four components: two rigid polyethylene rectus muscle splints (RMS), a circumferential dynamic retainer (CDR) “elastic binder”, and a diaphragm-type pressure gauge system connected to an inflation bulb.
The AbClo device is supported on the abdominal wall only by the tension generated between the two rectus abdominis muscle splints and the circumferential elastic binder around the patient’s back.
The circumferential elastic binder needs to be placed around the patient’s torso and centred along the spine, leaving a free end on each side of the patient. The RMS should be placed at least “5 cm” from the fascial edge of the OA, with the tensioning dial edge adjacent and parallel to the fascial defect.
The undersurface of the rectus abdominis muscle splint conforms to the lateral edge of the rectus abdominis muscle through its concave design and silicone padding. The splints have a crossbar with a locking mechanism to secure the binder.
Each splint has a pair of reel dials with stainless steel cables wrapped in nylon and cable anchoring cleats. The reel dials have a lock and release mechanism to secure the cables in place and regulate the tension force.
The gauge has four colored ranges of tension to facilitate monitoring of the safe tension zone, 35–65 mm Hg, “green zone”.
AbClo should always be placed on top of the temporary abdominal coverage “dressing” material to protect the skin, and should never be used over unprotected viscera.2
See https://abclomedical.com/instructions/ for more information.
Key Clinical Features of the AbClo Device
- Facilitating Access for Future Procedures: The AbClo device provides surgeons with continuous access to the abdominal cavity. This feature is crucial for monitoring signs of infection or other complications while still providing the necessary degree of closure that promotes healing. In cases where a second look or follow-up abdominal surgeries are required, the AbClo device can be removed and replaced to allow for full abdominal access.
- Pressure Regulation: One of the leading causes of morbidity in patients with open abdomens is compartment syndrome. The AbClo device regulates intra-abdominal pressure, reducing the risk of this potentially life-threatening condition.
- Reduced Complications: By improving fluid management and minimizing tissue edema, the AbClo device is designed to lower the incidence of complications often associated with traditional OA management, including infections and delayed healing.
- Ease of Use: With its user-friendly design, nursing teams can efficiently manage patients with open abdomens. The closure system allows for easier visualization of abdominal contents and simpler dressing changes, contributing to more efficient care protocols.
- Compatible with CT imaging: CT scans are particularly useful when used with AbClo, as the images can show how the device is effectively moving all the layers of the abdominal wall. This is beneficial in monitoring fascial closure progress, especially in patients with high BMI or those who require a colostomy. CT scans can also be used to identify any complications related to the abdominal wall closure or the function of the AbClo device.
AbClo Limitations
Among the contraindications for AbClo use are conditions that could prevent the device from being positioned on the abdominal wall or could be exacerbated by its application, such as abdominal wall necrosis or major burns.
Nevertheless, Intestinal stomas and abdominal compartment syndrome are not considered a contraindication for AbClo. In those cases, the RMS can be placed laterally to the stoma site, or an opening can be cut in the CDR binder to allow for stoma access, and a pressure gauge allows the tension to be adjusted accordingly.
Abdominal pressure should be monitored using standard hospital protocol. The AbClo tensioner bag and gauge do not measure abdominal pressure.
AbClo is not reusable on different patients; however, AbClo can be reused on the same patient.
It is also important to note that AbClo is only indicated for adult use and should not be used in pediatrics.
Role of AbClo in Complex Cases
- AbClo & High BMI Patients
AbClo can be used effectively with high BMI patients. Larger-sized CDR binders are available for use in these patients. AbClo has been used effectively in patients with a BMI of 71.
Clinical Advantages Observed in high-BMI Patients
- Rapid and Effective Fascial Closure: AbClo facilitated primary fascial closure despite patients’ high BMI, severe fluid overload, and multiple return trips to the operating room.
- Preservation of Abdominal Wall Integrity: The system’s dynamic tension allowed all layers of the abdominal wall to move together, enabling complete closure without complications. AbClo preserved both the fascia and skin, reducing further trauma to the abdominal wall, even in a challenging case involving prolonged OA.
- Streamlining Care: AbClo simplified the management of complex trauma in high-BMI cases. Achieving primary fascial closure despite prolonged open abdomen status and severe fluid shifts reduced the need for additional interventions, allowing for efficient care and a smoother recovery.
Complex Trauma Patients
AbClo’s unique design and functionality improved patient outcomes in complex trauma scenarios such as gunshot wounds to the abdomen and falls from heights trauma cases.
Key Outcomes with AbClo
- Facilitating Early Primary Fascial Closure: AbClo enabled primary fascial closure up to postoperative day 21 despite the severity of injuries and fluid status complications. The device’s consistent, dynamic appositional force gradually reduced the fascial defect, preventing further damage to the abdominal wall.
- Minimizing Complications: Using a single AbClo throughout the patient’s recovery prevented additional interventions, contributing to a safer, more controlled management pathway.
- Enhancing Operational Efficiency: Even with an initial 24-hour delay in placement, AbClo’s application effectively managed the open abdomen, mitigating risks associated with fluid imbalance and maintaining abdominal wall integrity until closure.
AbClo & Acute Care Surgery in Elderly Patients
Traditional management for such cases typically involves prolonged ICU stays, multiple surgical procedures, and significant morbidity. However, the implementation of AbClo demonstrated a more efficient and effective approach.
Clinical Advantages Observed in Elderly Patients
- Reliability in Fragile and Elderly Patients: Despite the age and initial morbidities of these patients, AbClo successfully regained the abdominal midline without increasing intra-abdominal pressure. The silicone under the pads of the rectus muscle splints curve with the rectus muscle, facilitating closure without additional concerns.
- Preservation of Abdominal Wall Integrity: The system’s dynamic tension maintained the reduction of the fascial defect without causing additional trauma to the skin or underlying fascia.
- Streamlining Care: Only one AbClo device was required for the entire treatment period, reducing patients’ exposure to repeated surgical procedures and overall costs.
In conclusion, even with complex cases, AbClo was realized to reduce ICU length of stay by up to 50% and cut down surgical takebacks by 25% 3(Comparison of Primary Fascial Closure Rate in Open Abdomen Management: Wittmann Patch versus Abdominal Fascia Closure Device. (Abstract)
Abosena W., Bawazeer M., et al. ACS. 2024.), which means less time under anesthesia and less exposure to post-surgical risks. Additionally, being non-invasive, AbClo also helps reduce additional surgical site incisions in the skin and fascia that are commonly found with other invasive, traction devices.
In the next part of this series, we will explore more insights from “WHAT’s Beyond” the AbClo, going deeper into AbClo’s published clinical studies and economic analysis, and how the findings further highlight cost savings and AbClo’s real economic value. As well as glimpses from future research related to AbClo.
REFERENCES
- Pommerening MJ, DuBose JJ, Zielinski MD, Phelan HA, Scalea ™, et. al. Time to first take-back operation predicts successful primary fascial closure in patients undergoing damage control laparotomy (2014). https://pubmed.ncbi.nlm.nih.gov/24962190/
- AbClo – Support Tools and Instructions for Use (2025). https://abclomedical.com/qr-tools/
- Wael Abosena, MD, Mohammed Bawazeer, MD, Marc Antoine Fortin, MD, Joao Rezende-Net,o MD, et. al. Comparison of Primary Fascial Closure Rate in Open Abdomen Management: Wittmann Patch versus Abdominal Fascia Closure Device. https://abclomedical.com/wp-content/uploads/2024/07/9.-Comparison-of-Primary-Fascial-Closure-Rate-in-Open-Abdomen-Management_-Wittmann-Patch-versus-Abdominal-Fascia-Closure-Device.-Wael-Abosena-Et-al.pdf