Why Open Abdomen Management Continues to Evolve

Open abdomen management remains one of the most complex areas of trauma and acute care surgery. While advances in resuscitation, damage control techniques, and temporary abdominal closure have improved patient survival, achieving reproducible, mesh-free primary fascial closure continues to present significant challenges.

During the AbClo Symposium at the Mattox TCCACS & MDR 2026 conference, trauma surgeons shared clinical experience, institutional protocols, and recently published evidence addressing many of the questions clinicians encounter when managing the open abdomen. This article summarizes several of the most frequently discussed topics from the symposium, drawing on published research and real-world experience from high-volume trauma centres.

Why is early fascial traction important?

One of the strongest themes throughout the symposium was the importance of addressing fascial retraction as early as possible.

Once the abdomen is intentionally left open, lateral forces generated by the severed abdominal wall musculature begin pulling the fascial edges apart. As hemodynamic instability and repeated operative interventions continue, primary fascial closure becomes progressively more difficult.

Clinical evidence presented during the symposium compared patients who received fascial traction within 24 hours of their initial laparotomy with those who received delayed treatment. Early placement resulted in a significant reduction of the fascial gap prior to closure and higher rates of primary fascial closure than delayed placement.

The presenters emphasized that while every patient requires individualized management, preventing fascial retraction early may improve the likelihood of successful closure regardless of the patient’s timeline to recovery.

Can primary fascial closure still be achieved after a failed closure attempt?

Yes, although patient selection and clinical judgment remain essential.

Several symposium presentations highlighted complex rescue cases in which patients had already undergone multiple abdominal operations or unsuccessful closure attempts before AbClo was introduced into their management.

One case involved a trauma patient whose previous primary closure attempt had failed and who had been bridged with absorbable mesh. Following removal of the mesh and progressive fascial traction with the AbClo, primary fascial closure was ultimately achieved.

These cases demonstrate that delayed or failed closure does not necessarily eliminate the possibility of definitive fascial closure when appropriate management strategies are implemented.

How do standardized open abdomen protocols improve patient care?

Open abdomen management extends far beyond the operating room.

Dr. Shiree Berry and Dr. Joshua Hazelton both described the value of standardized protocols that involve surgeons, residents, nursing teams, advanced practice providers, and intensive care staff throughout the patient’s treatment.

Rather than relying solely on individual decision-making, structured protocols help ensure:

• Early identification of patients at risk for loss of domain.
• Consistent monitoring throughout intensive care.
• Standardized documentation.
• Timely reassessment for fascial closure.
• Clear communication between multidisciplinary teams.

Although each institution developed its own workflow, both centres emphasized that consistency plays an important role in reproducibly achieving successful closure.

Does fascial traction reduce the risk of incisional hernia?

Recently published clinical evidence presented during the symposium suggests it may.

In a 2026 retrospective cohort study comparing patients managed with standard negative pressure wound therapy alone versus combined therapy with non-invasive fascial traction, it was demonstrated combined treatment led to higher primary fascial closure rates and significantly lower rates of incisional hernia.

Researchers also observed smaller fascial gap measurements at the time of closure among patients treated with non-invasive fascial traction, suggesting that maintaining abdominal wall integrity throughout treatment may contribute to improved long-term outcomes.

These findings reinforce that successful open abdomen management involves more than simply achieving closure. Preserving long-term abdominal wall function should be considered as achievable in all cases regardless of co-morbidities or management timelines.

What role does multidisciplinary care play in open abdomen management?

Open abdomen patients often transition between the operating room, surgical intensive care unit, and imaging centers.

For this reason, presenters repeatedly emphasized that successful management depends on coordinated care rather than isolated surgical decisions.

Education across the multidisciplinary team—including surgeons, fellows, residents, advanced practice providers, operating room staff, and ICU nurses—helps establish consistent expectations for monitoring, documentation, device management, and closure planning.

This collaborative approach was identified as an important component of standardized open abdomen protocols at both participating trauma centres.

What are the biggest priorities for trauma centres managing the open abdomen?

Although every patient presents unique clinical challenges, several priorities emerged consistently throughout the symposium:

• Identify patients at high risk for fascial retraction early.
• Develop standardized multidisciplinary care pathways.
• Minimize unnecessary delays in closure planning.
• Monitor fascial progression throughout treatment.
• Focus on both immediate closure and long-term abdominal wall integrity.

Collectively, these principles reflect an evolving approach to open abdomen management that emphasizes proactive planning, consistent care, and evidence informed decision making.

Looking Ahead

Open abdomen management continues to evolve as new clinical evidence, institutional experience, and multidisciplinary care pathways shape best practices.

The discussions presented during the AbClo Symposium highlighted the importance of early intervention, standardized protocols, and long-term outcome assessment when managing complex open abdomen cases. As additional registry data and multicentre studies become available, trauma surgeons will continue to refine strategies aimed at improving primary fascial closure while reducing complications and preserving abdominal wall function.

Whether you’re developing an open abdomen management protocol or exploring new approaches to primary fascial closure, AbClo provides clinicians with evidence-based resources, clinical education, and published research to support informed decision-making.

Explore our clinical evidence, case studies, and education resources to learn more.

References

1. Berry S. Management of Complex Open Abdomen Cases with AbClo. Presented at the Mattox TCCACS & MDR 2026 Satellite Symposium.
2. Hazelton J. Management of Complex Open Abdomen Cases with AbClo. Presented at the Mattox TCCACS & MDR 2026 Satellite Symposium.
3. Rezende-Neto J. Management of Complex Open Abdomen Cases with AbClo. Presented at the Mattox TCCACS & MDR 2026 Satellite Symposium.
4. Mahoney EJ, Bugaev N, Appelbaum R, et al. Management of the Open Abdomen: A Systematic Review with Meta-Analysis and Practice Management Guideline from the Eastern Association for the Surgery of Trauma. Journal of Trauma and Acute Care Surgery. 2022;93(3):e110-e118.
5. Noninvasive Fascial Traction Improves Primary Fascial Closure and Reduces the Incidence of Incisional Hernia in Open Abdomens. Journal of Trauma and Acute Care Surgery.