MANAGEMENT OF BURST ABDOMEN BY NEGATIVE PRESSURE THERAPY VERSUS DIRECT SKIN CLOSURE: A RANDOMIZED CONTROLLED TRIAL

Abstract

Burst abdomen, or abdominal wound dehiscence, involves partial or complete disruption of the abdominal wall, often leading to serious complications like morbidity, prolonged hospitalization, and high healthcare costs. Proper understanding of abdominal wall anatomy-including skin, fascia, muscles, blood supply, lymphatics, and innervations-is essential for effective surgical management. Burst abdomen incidence varies from 0.2% to 12%, influenced by patient comorbidities, surgical technique, and emergency versus elective procedures. Risk factors include malnutrition, diabetes, anemia, steroid use, and peritonitis. Management strategies are categorized into non-operative measures and multiple operative techniques under temporary abdominal closure (TAC). Options include Bogota bag, Wittmann Patch, skin-only closure, simple packing, mesh applications, and vacuum-assisted closure (VAC). Among these, VAC therapy has gained prominence for promoting granulation tissue, reducing edema, enhancing bacterial clearance, and accelerating wound healing. However, despite promising results, few studies have directly compared VAC therapy and conventional methods like skin closure in post-laparotomy wound dehiscence, justifying the need for this study.