A Prospective, Controlled Evaluation of the Abdominal Reapproximation Anchor Abdominal Wall Closure System in Combination with VAC Therapy Compared with VAC Alone in the Management of an Open Abdomen KRISTIN L. LONG, M.D., DAVID A. HAMILTON, M.D., DANIEL L. DAVENPORT, PH.D., ANDREW C. BERNARD, M.D., PAUL A. KEARNEY, M.D., PHILLIP K. CHANG, M.D. From the Division of General Surgery–Trauma and Critical Care, Department of Surgery, University of Kentucky, Lexington, Kentucky Dramatic increases in damage control and decompressive laparotomies and a significant increase in patients with open abdominal cavities have resulted in numerous techniques to facilitate fascial closure. We hypothesized addition of the abdominal reapproximation anchor system (ABRA) to the KCI Abdominal Wound Vac TM (VAC) or KCI ABThera TM would increase suc- cessful primary closure rates and reduce operative costs. Fourteen patients with open abdomens were prospectively randomized into a control group using VAC alone (control) or a study group using VAC plus ABRA (VAC-ABRA). All patients underwent regular VAC changes; patients re- ceiving VAC-ABRA also underwent concomitant daily elastomer adjustment of the ABRA system. Primary end points included abdominal closure, number of operating room (OR) visits, and OR time use. Eight patients were included in the VAC-ABRA group and six patients in the control group. Primary closure rates between groups were not statistically different; however, the number of trips to the OR and OR time use were different. Despite higher Acute Physiology and Chronic Health Evaluation II scores, larger starting wound size, and higher rates of abdominal compart- ment syndrome, closure rates in the VAC-ABRA group were similar to VAC alone. Importantly, however, fewer OR trips and less OR time were required for the VAC-ABRA group. F OR THE LAST 20 to 30 years, damage control and decompressive laparotomies have emerged as part of the armamentarium for treatment of complex ab- dominal trauma, abdominal compartment syndrome, and critically ill surgical patients with profound aci- dosis. 1 Although these advances have saved lives, they have also led to a dramatic increase in patients with open abdominal cavities. 2 Various methods have been used to offer protection to the viscera and at the same time encourage gradual closure of the abdominal fas- cia. These techniques include the Bogota bag, the vac- uum pack described by Barker, 3 the Wittman Patch, 4 and the use of vacuum-assisted fascial closure such as the commercially available Abdominal Wound Vac TM Open Abdomen Negative Pressure Therapy System (VAC) offered by KCI (KCI International, San Antonio, TX). Overall, reported VAC abdominal closure rates range from 50 to 88 per cent over an average of 10 days. 5 Additionally, optimal results often require returning to the operating room (OR) every three to five days. Un- fortunately, no well-designed prospective comparison studies of currently available abdominal closure de- vices exist. At the University of Kentucky Medical Center, a combination of the vacuum pack dressing described by Barker, the commercially available VAC, and VICRYL TM mesh closure systems is commonly used. The primary fascial closure rate is approximately 50 per cent. A novel approach to encourage gradual closure of abdominal fascia is the use of progressive tensioning with sutures or other mechanisms. A randomized pro- spective trial comparing sequential suturing combined with VAC with VAC alone examined primary closure rates of 30 open abdomen patients. Subjects in this study Address correspondence and reprint requests to Kristin L. Long, M.D., Department of Surgery, Division of General Surgery, Uni- versity of Kentucky, 800 Rose Street, C-224, Lexington, KY 40536-0298. E-mail: Kristin.long@uky.edu. This study was partially funded by Canica Design, Inc. 567