The vacuum assisted closure device has been used to treat both full thickness and partial thickness wounds of the abdominal wall. A total of 90 patients were treated. Thirty patients were treated for a full thickness wound of the abdominal wall with loss of integrity of skin, muscle and fascia. Sixty patients were treated for a partial thickness loss of the abdominal wall with intact fascia and/or muscle. Patients range in age from infancy to 78 years; 43 males and 47 females were treated. Gastroschisis, abdominal compartment syndrome, traumatic loss of abdominal wall and/or postop surgical complications of infection, dehiscence and necrosis were all treated.

The vacuum assisted closure device provided a controlled stable temporary abdominal wall for the 30 full thickness abdominal wounds. V.A.C. treatment in both full thickness and partial thickness abdominal wound groups range from 11 to 14 days. Final closure in the group of 30 patients with full thickness abdominal wounds consisted of 12 delayed primary closures with all layers closed from skin to fascia. Relaxing incisions and muscle flaps were performed in 2 of these 12 patients. Three patients were treated with skin closures; muscle fascia closures were not possible. Seven patients required skin grafts and in 6 patients the V.A.C. alone was used to close skin. In these latter 2 groups comprising 13 patients, 11 required mesh. Two patients died prior to closure.

Of the 60 patients with partial thickness loss of the abdominal wall, fascia and/or muscle was intact. Thirteen of these patients underwent delayed primary closure of the skin, 26 were closed with skin grafts and 21 closed by V.A.C. alone.

Complications in the 60 partial thickness wounds included: 1 wound infection following delayed primary closure, 3 wound infections in the closure by the V.A.C. alone and 1 partial skin graft loss due to infection. Complications in the 30 full thickness wounds included 1 abdominal wall abscess, 1 intra-abdominal abscess, 1 evisceration and 3 deaths, 2 before closure and 1 after abdominal wall closure. The deaths were not related to sepsis from the use of the vacuum assisted closure device.

Conclusions. The vacuum assisted closure device provided temporary abdominal wall closure in the full thickness abdominal wall wounds which controlled evisceration and removed a significant amount of intra-abdominal edema. Clinically it was felt that more delayed primary closures were possible with the use of the V.A.C. than without the use of the V.A.C.. The abdominal wounds in this group became significantly smaller with the traction effect of the V.A.C. on the wound within the 11 to 14 day time frame. There was increased quality of abdominal wall closure and a decreased time to closure clinically in both the full thickness wound and partial thickness wound groups.