• Doğan Alhan, İsmail Şahin, Serbülent Güzey, Andaç Aykan, Fatih Zor, Serdar Öztürk, Mustafa Nışancı, and İsmail Hakkı Özerhan.
• Department of Plastic, Reconstructive and Aesthetic Surgery, Eskisehir Military Hospital, Eskisehir, Turkey.
• Ulus Travma Acil Cer. 2015 Dec 1; 21 (6): 457-62.

BackgroundOpen abdomen is a salvage procedure that prevents catastrophes after severe intraabdominal traumas. However, following this life saving attempt, it is mostly not feasible to close the abdomen immediately after the recovery of intraabdominal injuries. Consequently, a staged reconstruction is required, and the first stage is usually a temporary closing approach. At the end of this stage, resulting giant "ventral hernia" is a burden for both the patient and the surgeon. Therefore a permanent repair is subsequently needed. Although there are many treatment modalities described for this goal, etiologies like high-energy gunshots may cause an exactly nuisance scene which can limit treatment options and reduce final success. Herein, it was the objective of this study to present our staged protocol to restore the abdominal wall defect and strategy for optimizing the results in such conundrum cases.MethodsTreatment was performed on nine male patients suffering from severe open abdomen due to high-energy gunshot injury. In all patients, temporary closure was provided by negative pressure wound treatment applied directly to the viscera and followed by skin grafting. Late permanent closure was performed with the lamination of expanded abdominal skin and dual-sided meshes.ResultsThe follow-up period ranged between 24 months to 4.5 years (mean, 3 years). During this period, no recurrence of ventral hernia, enteric fistula formation, abdominal infection and seroma formation was observed in any patient.ConclusionIn this study, NPWT, tissue expansion and dual-sided mesh were used together as a staged procedure for optimizing the results in the clinical scenario of an open abdomen due to high-energy gunshot wound. Results were highly satisfactory for patients and acceptable aesthetically.

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