Since their inception into surgical practice, open abdomens have been a notoriously risky critical care pathway. As with any open wound, exposure to contaminants that lead to infection – combined with the body’s natural inclination to restore normal function through inflammatory responses and granulation – can make it difficult for the wound to close. These risks are exponentially elevated in open abdomen care as viscera and the abdominal wall are easily sent into disarray via midline incisions.  

Luckily, as this surgical technique has evolved, management methods now act as functional surrogates for the abdominal wall – protecting the viscera while preserving tension and facilitating progressive closure. 

This commentary will highlight the past risks of open abdomen care while showcasing the low-risk potential of AbClo in restoring physiologic activity of the abdominal wall.  

The Usual Suspects of Open Abdomen Complications 

The usual complications in open abdomens – except fistulas – are typical of most open wounds but exacerbated by the risks of exposing abdominal viscera to external contaminants. Most common complications include: infection and sepsis, fluid and electrolyte imbalance, abdominal wall retraction and fascial dehiscence, and enterocutaneous fistulas (ECFs).  

Opening an abdominal wall down the midline reveals the internal organs to the external environment. As the external air dries out the tissues, infection from external microbes can take hold within the abdominal cavity and easily lead to sepsis – a life-threatening condition. This exposure also rapidly removes fluids and electrolytes from the tissues that are used to the protection provided by the abdominal wall and skin.  

Once an open abdomen remains unclosed past the 72-hour mark, the risk of abdominal wall retraction increases. The fluid-deprived fascia can additionally retract and harden in a process known as dehiscence. These two processes make it increasingly difficult to regain the midline for eventual closure once loss of domain has occurred. 

One of the most dangerous complications is that of ECFs. These are unwanted adhesions of the intestines to the abdominal wall. Fistula formation can lead to sepsis, malnutrition, and prolonged hospitalization.  

Re-Establishing Physiological Function 

The immediate goal following a left-open laparotomy is to restore physiologic function of the abdominal wall and protect the underlying viscera and fascia from complications.  The current standard of care calls for a negative pressure wound dressing as a major component of this temporary restoration.  

Negative pressure wound therapy (NPWT) acts as a temporary abdominal closure, covering the open wound while removing fluids with a negative pressure pump. A common and highly effective version of NPWT is the AbThera dressing by Solventum. AbThera is exceptional at fluid management – reducing the risk of sepsis and fluid loss – but it does not combat abdominal wall retraction.

To truly restore physiologic function, a traction device is required. Traction devices can restore the abdominal cavity to a normal interstitial pressure while preventing further loss of domain. 

In the past, only invasive traction devices were available. These would often break the seal of NPWT, leading to fluid leakage, higher fistula rates and further damage to the skin and fascia. Although these traction devices can help with reapproximation of the midline, the increased risk of other complications makes them unfavourable for use and may discourage open abdomen techniques altogether. 

Reducing Risks with Non-Invasive Traction 

Non-invasive fascial traction can help regain the midline of open abdomens without inducing further damage to the skin, muscle or fascial edges. This actively combats fascial retraction and dehiscence, allowing for closure with fewer complications and cleaner margins for final suturing – ultimately leading to lower hernias in the long run. 

AbClo currently leads the charge for non-invasive fascial traction devices. With circumferential inwards force and dynamic midline traction enforced by the rigid splints placed close to the incisional edge, AbClo helps restore physiologic function.  

AbClo: Low Risk, High Closure Rates 

As a non-invasive procedure, complications stemming directly from its use are limited to possible skin breakdown or blistering. Fortunately, these risks can be easily mitigated through the use of proper skin protection and patient monitoring. 

The last step in reducing risk is using AbClo in tandem with NPWT – maximizing patient success by tackling all common complications of the open abdomen. The combined use of AbClo and NPWT has been investigated before, and the results are astounding: nearly 100% closure rates, lower incidences of secondary complications and a likely massive decrease in eventual hernia rates.

With the novel capabilities of AbClo paired with NPWT, it has sparked conversation on the current risks of open abdomen care. Hopefully, this thought piece shows that although this surgical technique may have held more risk 15 years ago, modern innovation has transformed it into a safe and reliable method to manage complex patients – without fear of further damage or lack of closure.