Data_Sheet_1_Dynamic Fascial Closure With Vacuum-Assisted Wound Closure and Mesh-Mediated Fascial Traction (VAWCM) Treatment of the Open Abdomen—An Updated Systematic Review.DOCX

Introduction: Several different temporary abdominal closure techniques are described in the context of open abdomen treatment. Techniques based on dynamic fascial closure combined with negative pressure therapy have gained popularity and seem to result in the highest fascial closure rates without increased complications and are highlighted in recent guidelines and recommendations. One dynamic closure technique is the vacuum-assisted wound closure and mesh-mediated fascial traction (VAWCM) technique, first described in 2007. The aim of this systematic review was to evaluate the VAWCM technique regarding a number of short- and long-term results.Materials and Methods: A systematic literature search was performed in PubMed, EMBASE, and Cochrane Library databases for articles published between January 1, 2006 and May 8, 2020. The review was independently performed by the two authors according to the PRISMA statements for reporting systematic reviews and meta-analyses. Results were pooled for presentation of weighted means when applicable.Results: A total of 220 articles were screened by title and abstract. Thirty-two articles were assessed for eligibility by full-text review and 15 articles finally remained for review. A total of 600 patients treated with VAWCM were included. The pooled weighted means were as follows: fascial closure, 83.5%; enteroatmospheric fistula, 5.6%; planned ventral hernia, 6.2%; in-hospital survival, 72%; and incisional hernia incidence, 40.5%. Long-term survival ranged between 22 and 72%. Quality of life (SF-36) was reported in two studies showing lower scores than the population mean especially in physical domains. Incisional hernia resulted in lower scores in one but not in the other study.Discussion: The results of 600 VAWCM-treated patients from 15 studies were evaluated in this systematic review. Earlier findings with high fascial closure rates, low enteroatmospheric fistula, and planned ventral hernia rates as well as high incisional hernia incidences were underlined. Permanent mesh for efficient fascial traction and reinforcement at fascial closure seem to be the next step in evolving an optimal temporary closure technique in open abdomen treatment.

引言：本文对开放腹部治疗过程中所描述的多种临时腹部闭合技术进行了阐述。基于动态筋膜闭合与负压疗法的闭合技术因其较高的筋膜闭合率且并发症增加不明显而受到青睐，并在最新的指南和建议中得到了强调。其中一种动态闭合技术为真空辅助伤口闭合与筋膜牵张（VAWCM）技术，该技术首次于2007年进行描述。本次系统综述的目的是评估VAWCM技术在短期和长期结果方面的应用。材料与方法：在PubMed、EMBASE和Cochrane图书馆数据库中进行了系统文献检索，检索范围涵盖2006年1月1日至2020年5月8日之间发表的文献。两位作者根据PRISMA声明对系统综述和荟萃分析进行独立评估。当适用时，对结果进行了加权平均值的汇总。结果：通过标题和摘要筛选出220篇文章。经过全文审查，32篇文章符合评估标准，最终15篇文章被纳入综述。共有600名接受VAWCM治疗的患者。汇总的加权平均结果如下：筋膜闭合率，83.5%；肠气瘘，5.6%；计划性腹壁疝，6.2%；住院生存率，72%；切口疝发生率，40.5%。长期生存率介于22%至72%之间。两项研究表明，生活质量（SF-36）得分低于人群平均水平，尤其是在生理领域。在一项研究中，切口疝导致得分降低，而在另一项研究中则没有。讨论：本次系统综述对来自15项研究的600名接受VAWCM治疗的患者进行了评估。强调了早期研究发现的高筋膜闭合率、低肠气瘘和计划性腹壁疝率以及高切口疝发生率。对于开放腹部治疗中的临时闭合技术，使用永久性网状结构以实现高效的筋膜牵张和闭合时的加固，可能是优化技术发展的下一步。