Negative pressure wound therapy for children with an open abdomen

The utility of negative pressure wound therapy (NPWT) in the management of adults with an open abdomen has been well documented. We reviewed our experience with NPWT in the management of infants and children with this condition.

The records of all children who were treated with NPWT for an open abdomen between March 2005 and September 2009 at a single children’s hospital were reviewed.

Twenty-five subjects were identified. They included children who developed abdominal compartment syndrome after a laparotomy (n = 12) or in whom the abdomen could not be safely closed at the time of laparotomy (n = 13). NWPT was accomplished with the vacuum-assisted closure (VAC®) system in all patients. The median duration for NPWT was 4.5 days. In 16 subjects, the abdomen was closed successfully after NPWT. In 14 children, the abdominal wall fascia was successfully approximated, and two children underwent a patch abdominal closure. But nine subjects died before an abdominal closure could be attempted. Only two (12.5%) children developed enterocutaneous fistulae.

NPWT is a reliable tool for infants and children with an open abdomen. Wound management was facilitated and abdominal wall closure was ultimately achieved in all survivors. Enterocutaneous fistulae developed in two children, however, these were likely due to underlying bowel injury and would have occurred despite variations in management of the open abdomen.