Introduction: Abdominal dehiscence is associated with high morbidity and mortality. Management is particularly difficult in patients with compromised wound healing. VAC therapy may potentially be used for these patients to improve wound healing, reduce infection, and/or reduce dressing change frequency.

Methods: A treatment protocol was designed to improve surgical outcomes in patients with abdominal dehiscence and have comorbidities that may compromise wound healing. The vacuum assisted closure device (VAC) was used to provide temporary wound coverage and promote healing during an intermediate period, and definitive closure was performed in a delayed setting, if required.

Results: Twenty patients with mean age of 48 years (range, 5-75 years) were included in the study. All patients developed dehiscence within 1 week following laparotomy for oncologic resection (10 patients), trauma (4), ventral hernia (3), cesarean section (2), or aortic aneurysm repair (1). All patients had at least 1 systemic comorbidity that could compromise wound healing and 13 patients had 2 or more; these included obesity (9 patients), diabetes (10), steroid use (4), smoking (6), hypertension (7), and preoperative chemotherapy (4). Eight of the 20 patients had fascial dehiscence with frank evisceration. The VAC was applied directly onto the bowel in each of these 8 patients, and definitive fascial closure was performed in 6 of the 8 patients using component separation or fascial advancement, either with (3 patients) or without (3 patients) placement of polypropylene mesh. Stable cutaneous coverage was subsequently achieved in all patients by placement of a skin graft (8 patients), advancement skin flaps (6), or reepithelialization of the wound (6). Five of the 20 patients received a portion of their VAC therapy as outpatients; the other 15 remained hospitalized while the VAC was used. The endpoint for VAC therapy, based on clinical judgment, was when the wound had achieved stable cutaneous coverage or was able to be closed surgically with a skin graft or component separation. The mean length of VAC therapy was 4 weeks (mean, 2-21 weeks). Complications occurred in 3 patients: enterocutaneous fistulae in 2 patients and complete skin graft loss in another.

Conclusions: A treatment protocol with VAC therapy and delayed definitive closure was used to achieve stable wound closure following abdominal dehiscence in all 20 compromised patients with relatively few complications. VAC treatment was well tolerated and precluded the use of frequent dressing changes. This treatment protocol should be considered for the management of patients with abdominal dehiscence.