The document discusses open abdomen techniques and management. It defines open abdomen as requiring temporary abdominal closure after laparotomy when the skin and fascia cannot be primarily closed. Common causes for open abdomen include necrotizing fasciitis, severe bowel edema, peritonitis, and gross abdominal contamination. Temporary abdominal closure techniques discussed include simple packing, skin closure, Bogota bag, mesh, and Wittmann patch. More recently, negative pressure wound therapy including vacuum-assisted closure and variants like AB Thera have gained popularity due to advantages like improved drainage and wound contraction allowing higher rates of fascial reapproximation. The main goal of open abdomen treatment remains achieving definitive abdominal wall closure, preferably within 8 days to reduce complications.
Component seperation technique for the repair of very large ventral hernias nikhilameerchetty
Includes all the ventral hernia repairs with the loss of domain and the various methods of component separation technique with their success rate for their repair ,few videos showing the methods of repair in addition to the latest techniques of repair .
LAPAROSCOPIC INGUINAL HERNIA REPAIR- OPERATIVE SURGERY
#surgicaleducator #operativesurgery #laparascopicinguinalherniarepair #usmle #babysurgeon #surgicaltutor
Dear viewers,
• Greetings from “Surgical Educator”
• Because of the popular demand by viewers of the YouTube channel “Surgical Educator”, I have decided to create and upload videos on common surgeries.
• I have already uploaded videos on open and Laparoscopic Appendicectomy, Thyroidectomy, Modified Radical Mastectomy and open and
Laparoscopic Cholecystectomy and Open inguinal hernia repair
• In this video today, I have discussed Laparoscopic Inguinal Hernia Repair- both TAPP and TEP approaches.
• However, these videos are not real surgeries but the theoretical aspect of operative surgery like going through an atlas of operative surgery.
• Along with these videos, I recommend you to watch real operative surgery videos as well and I will give a link for each surgery in the end of the video as end-cards, which I think will be very useful.
• This will give a very good opportunity for the surgical trainees to mentally rehearse various surgical steps in a sequential manner prior to actual surgery. You can watch the video in the following links:
• surgicaleducator.blogspot.com
• youtube.com/c/surgicaleducator
• Thank you for watching the videos.
Component seperation technique for the repair of very large ventral hernias nikhilameerchetty
Includes all the ventral hernia repairs with the loss of domain and the various methods of component separation technique with their success rate for their repair ,few videos showing the methods of repair in addition to the latest techniques of repair .
LAPAROSCOPIC INGUINAL HERNIA REPAIR- OPERATIVE SURGERY
#surgicaleducator #operativesurgery #laparascopicinguinalherniarepair #usmle #babysurgeon #surgicaltutor
Dear viewers,
• Greetings from “Surgical Educator”
• Because of the popular demand by viewers of the YouTube channel “Surgical Educator”, I have decided to create and upload videos on common surgeries.
• I have already uploaded videos on open and Laparoscopic Appendicectomy, Thyroidectomy, Modified Radical Mastectomy and open and
Laparoscopic Cholecystectomy and Open inguinal hernia repair
• In this video today, I have discussed Laparoscopic Inguinal Hernia Repair- both TAPP and TEP approaches.
• However, these videos are not real surgeries but the theoretical aspect of operative surgery like going through an atlas of operative surgery.
• Along with these videos, I recommend you to watch real operative surgery videos as well and I will give a link for each surgery in the end of the video as end-cards, which I think will be very useful.
• This will give a very good opportunity for the surgical trainees to mentally rehearse various surgical steps in a sequential manner prior to actual surgery. You can watch the video in the following links:
• surgicaleducator.blogspot.com
• youtube.com/c/surgicaleducator
• Thank you for watching the videos.
Lt hemicolectomy - Surgical Approach, Complications.Vikas V
This is a detailed Presentation of the surgical procedure - Left Hemicolectomy. It deals with the Surgical anatomy, Indications, Surgical Steps, Complications of the Procedure
OPEN RIGHT HEMICOLECTOMY- STEP BY STEP OPERATIVE SURGERY
#surgicaleducator #operativesurgery #openrighthemicolectomy #usmle #babysurgeon #surgicaltutor
Subscription Link: http://youtube.com/c/surgicaleducator...
Surgical Educator Android App link: https://play.google.com/store/apps/de...
Dear viewers,
• Greetings from “Surgical Educator”
• Because of the popular demand by viewers of the YouTube channel “Surgical Educator”, I have decided to create and upload videos on common surgeries.
• In this video today, I have discussed Open Right Hemicolectomy .
• However, these videos are not real surgeries but the theoretical aspect of operative surgery like going through an atlas of operative surgery.
• Along with these videos, I recommend you to watch real operative surgery videos as well and I will give a link for each surgery in the end of the video as end-cards, which I think will be very useful.
• This will give a very good opportunity for the surgical trainees to mentally rehearse various surgical steps in a sequential manner prior to actual surgery. You can watch all my teaching videos in the following link:
• youtube.com/c/surgicaleducator
• Thank you for watching the videos.
Ventral hernia is protrusion of peritoneal sac through anterior abdominal wall defects except Groin hernias. In this presentation I have discussed Epigastric, Umbilical, Para umbilical, Incisional, Spigelian and Lumbar hernias.
Component separation technique for a very large abdominal wall herniaSanjiv Haribhakti
Component separation technique is an excellent technique for large ventral central defects which can allow a medial shift of approx. For More information visit at Gisurgery.info
VARIOUS Temporary CLOSURE TECHNIQUES IN OPEN ABDOMEN.pptxSyedSherazAli10
VARIOUS Temporary CLOSURE TECHNIQUES IN OPEN ABDOMEN & MULTIPLE RESEARCHES ON BOGOTA BAG
OPEN ABDOMEN;THE WORLD SOCIETY OF ABDOMINAL COMPARTMENT SYNDROME (WSACS) DEFINITION
"Open Abdomen (OA) is defined as one that requires Temporary Abdominal Closure (TAC) due to skin and fascia being not closed after laparotomy“
The first person to describe the use of open abdomen technique was Andrew J. McCosh in 1897 for generalized peritonitis however this approach was unusual at that time and was not received well at that time
Management of Open abdomen;
1) General management
General management
IV Fluids
Heat loss control
Analgesia & sedation
Nutrition
2) Wound management
Temporary abdominal closure (T.A.C.)
Dressing
Definitive closure
Lt hemicolectomy - Surgical Approach, Complications.Vikas V
This is a detailed Presentation of the surgical procedure - Left Hemicolectomy. It deals with the Surgical anatomy, Indications, Surgical Steps, Complications of the Procedure
OPEN RIGHT HEMICOLECTOMY- STEP BY STEP OPERATIVE SURGERY
#surgicaleducator #operativesurgery #openrighthemicolectomy #usmle #babysurgeon #surgicaltutor
Subscription Link: http://youtube.com/c/surgicaleducator...
Surgical Educator Android App link: https://play.google.com/store/apps/de...
Dear viewers,
• Greetings from “Surgical Educator”
• Because of the popular demand by viewers of the YouTube channel “Surgical Educator”, I have decided to create and upload videos on common surgeries.
• In this video today, I have discussed Open Right Hemicolectomy .
• However, these videos are not real surgeries but the theoretical aspect of operative surgery like going through an atlas of operative surgery.
• Along with these videos, I recommend you to watch real operative surgery videos as well and I will give a link for each surgery in the end of the video as end-cards, which I think will be very useful.
• This will give a very good opportunity for the surgical trainees to mentally rehearse various surgical steps in a sequential manner prior to actual surgery. You can watch all my teaching videos in the following link:
• youtube.com/c/surgicaleducator
• Thank you for watching the videos.
Ventral hernia is protrusion of peritoneal sac through anterior abdominal wall defects except Groin hernias. In this presentation I have discussed Epigastric, Umbilical, Para umbilical, Incisional, Spigelian and Lumbar hernias.
Component separation technique for a very large abdominal wall herniaSanjiv Haribhakti
Component separation technique is an excellent technique for large ventral central defects which can allow a medial shift of approx. For More information visit at Gisurgery.info
VARIOUS Temporary CLOSURE TECHNIQUES IN OPEN ABDOMEN.pptxSyedSherazAli10
VARIOUS Temporary CLOSURE TECHNIQUES IN OPEN ABDOMEN & MULTIPLE RESEARCHES ON BOGOTA BAG
OPEN ABDOMEN;THE WORLD SOCIETY OF ABDOMINAL COMPARTMENT SYNDROME (WSACS) DEFINITION
"Open Abdomen (OA) is defined as one that requires Temporary Abdominal Closure (TAC) due to skin and fascia being not closed after laparotomy“
The first person to describe the use of open abdomen technique was Andrew J. McCosh in 1897 for generalized peritonitis however this approach was unusual at that time and was not received well at that time
Management of Open abdomen;
1) General management
General management
IV Fluids
Heat loss control
Analgesia & sedation
Nutrition
2) Wound management
Temporary abdominal closure (T.A.C.)
Dressing
Definitive closure
The DIFFICULT ABDOMEN by DR.ABU (Based on sabiston).pdfDr.Abu Anil John
This is detailed ppt on the difficult abdominal wall chapter in sabiston..instead of reading the whole chapter you can skim through this ppt to get an idea..also you can take this in your presentation..enjoy
ABDOMINAL INCISIONS AND LAPAROTOMY-1.pptxAbhijitAzeez
The theoretical advantage of a paramedian over a midline incision is
a diminished risk of wound dehiscence and incisional hernia
In practice, when these incisions are reopened, the medial edge of the rectus muscle is frequently adherent to the anterior or posterior sheath incision and does not effectively buttress the wound.
A “lateral paramedian incision” refers to a vertical incision created several centimeters lateral to the location of the traditional paramedian incision.
In the patient who has had prior abdominal surgery, the cosmetic advantages of reentering the abdomen through a preexisting scar must be balanced against the challenges associated with dissection in a reoperative field. Close proximity of a new incision to an old one should be avoided in order to minimize the risk of ischemic necrosis of intervening skin and fascial bridges.
Mass closure of the abdominal wall is usually advocated, using large bites and short steps in the closure technique and either non-absorbable (e.g. nylon or polypropylene) or very slowly absorbable suture material (e.g. polydioxanone suture (PDS)). It has been estimated that, for abdominal wall closure, the length of the suture material should be at least four times the length of the wound to be closed to minimise the risk of abdominal dehiscence or later incisional hernia.
Vacuum Assisted Closure (VAC): A Promising Therapeutic Tool for Enterocutaneo...KETAN VAGHOLKAR
Managing an enterocutaneous fistula continues to pose the greatest challenge to the general surgeon. Aggressive supportive care is pivotal in managing these patients. Vacuum assisted closure (VAC) therapy is a promising therapeutic tool for such patients. It undoubtedly helps in closure of the fistula thus avoiding the high morbidity and mortality associated with surgical intervention. A case of a complex enterocutaneous fistula treated by VAC therapy is presented.
Cesarean delivery (C-section) is a surgical procedure used to deliver a baby through incisions in the abdomen and uterus. A C-section might be planned ahead of time if you develop pregnancy complications or you've had a previous C-section and aren't considering a vaginal birth after cesarean (VBAC).
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We're committed to being your source for expert health guidance. Bhaskar Health and Medical Education.
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Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Best Ayurvedic medicine for Gas and IndigestionSwastikAyurveda
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
The Gram stain is a fundamental technique in microbiology used to classify bacteria based on their cell wall structure. It provides a quick and simple method to distinguish between Gram-positive and Gram-negative bacteria, which have different susceptibilities to antibiotics
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
2. THE WORLD SOCIETY OF ABDOMINAL COMPARTMENT
SYNDROME (WSACS) DEFINITION
“Open Abdomen (OA) is defined as one that requires Temporary
Abdominal Closure (TAC) due to skin and fascia being not closed after
laparotomy”
The first person to describe the use of open abdomen technique was
Andrew J. McCosh in 1897 for generalized peritonitis however this
approach was unusual at that time and was not received well at that time
The OA process recently became popular in the context of damage control
surgery (DCS)
3. WHERE THE ABDOMEN CANNOT BE CLOSED
1. Necrotising fascitis of abdomen wall
2. Severe bowel edema
3. Severe peritonitis
4. Gross abdominal contamination
WHEN THE ABDOMEN SHOULD NOT BE CLOSED
1. IAH (intra-abdominal hypertension)
2. ACS (abdominal compartment syndrome)
3. DCS (damage control surgery)
4. 1.
INCISION TYPE - midline aw higher
incidence than tranverse
2.
CLOSURE - hasty closure
3.
Too small bites of fascia
4.
SUTURE MATERIAL - short absorbable
suture
5.
SUTURE LENGTH TO WOUND LENGTH RATIO
should be 4:1 (less than this causes
wound disruption).
6. Elevation of intra abdominal pressure :
Coughing
Ileus
Straining
Severe bowel edema
Urinary retention
Wound infection
Radiation therapy
7. Lateralization of the abdominal wall is defined as a phenomenon
where the musculature and fascia of the abdominal wall, most
exemplified by the rectus abdominis muscles and their enveloping
fascia, move laterally away from the midline with time.
8.
9. WSACS GRADING :
GRADE 1 : 12-15mmHg
GRADE 2 : 16 – 20mmHg
GRADE 3 : 21 – 25mmHg
GRADE 4 : >25mmHg
The abdominal perfusion pressure (APP),
analogous to the cerebral perfusion pressure, has
been proposed as a more accurate predictor of
visceral perfusion and consequently a target for
intervention. A target APP of ≥60 mmHg is
associated with improved survival in the setting
of IAH and ACS
10. ACS is defined as Sustained IAP >20 mmHg
(with or without APP <60 mmHg) that is
associated with a new organ dysfunction or
failure manifested as,
11. • Dehiscence usually declares itself 7-14 days post op and may
come wo warning.
• An otherwise unexpected serosanguinous discharge from the
wound is the most common forerunner of disruption .
• Patient may even complain of “something giving way”
12. 1. Heat loss : It is the most devastating problem of OA
occurring due to exposed bowel loops causing evaporation
2. Fluid loss
3. Bleeding: Sources of bleeding may be omentum or wound
edge or dilated fragile vessels of granulation tissue.
4. Hernia formation due to weakness of abdominal wall.
13. 5. Intestinal fistulation (Entero atmospheric fistula)
Predisposing factors :
1. Bowel exposure to air causing drying and dessication of serosa.
2. Injury caused by wound dressing .
3. Exposed suture lines .
4. Shearing force of the bowel adherent to abdomen wall or mesh.
5. Negative pressure wound therapy
6. Psychological disturbance
14. Temporary abdominal closure (TAC)
techniques form the major management
strategy for open abdomen
15. • 1. SIMPLE PACKING :
• Simple packing was the most commonly used technique in the
1980’s consisting of placing non adherent wet gauzes or
hydrophilic dressings directly on top of the abdominal
contents without the use of any sutures
• DISADVANTAGES :
• High mortality rates (approx. 30%)
• Wound left to heal by contraction leading to reconstructive
procedures later
• Fluid and protein loss, fistulization, hemorrhage
16.
17. 2. SKIN-ONLY CLOSURE TECHNIQUES
• Use the skin to provide some abdominal wall
stability with containment of abdominal viscera by
techniques like using a series of towel clips or a
rapid monofilament running sutures
Disadvantages:
• Increased risk of evisceration as bursting pressure
of skin is low
• Infection
• Injury and loss of skin
• Recurrent ACS
18.
19. 3. BOGOTA BAG :
• The BOGOTA bag was named so by mattox while observing
in bogota, Columbia uses a large presterilised bowel bag to
cover the intraabdominal viscera.
• DISADVANTAGES :
• Bogota bag does not prevent abdominal wall retraction
• Effective removal of abdominal fluids is not present
20.
21. 4. MESH :
• Involves suturing of a prosthetic mesh along
the fascial edges
• Types
• Non absorbable – polypropylene ,
polytetrafluoroethylene(ePTFE).
• Absorbable – polyglactin 910(vicryl) ,
polyglycolic acid
• Disadvantages – infection , fistulisation
22.
23. 5. WITTMANN PATCH :
• The WITTMANN PATCH also called “artificial burr”
consists of two detachable components a loop sheet
and a closure sheet
• Typically the patch is sutured to the abdominal fascia
and sequentially tightened every 24 – 48 hrs until
fascia is 2-4cm apart
• This method is used in cases where primary closure
cannot be achieved within 10 days to prevent fascial
retraction.
24.
25. DISADVANTAGES :
• More costly
• Requires suturing to the abdominal fascia
which increases risk of fascial trauma and
necrosis
• Risk of incisional hernias
• Does not evacuate peritoneal fluid adequately
and hence abdominal wound drainage may
become an issue.
26. In the management of OA the aforementioned
methods often need frequent and time
consuming changing of dressing, intensive
nursing and prolonged treatment before final
wound closure.
Moreover they do not offer built in drainage
systems to drain peritoneal fluids
Hence there came a concept of negative
pressure therapy (NPT) to overcome the
above challenges
27. Works by the concept of reverse tissue
expansion in the wound bringing together the
wound edges
Advantages :
• Increases local blood perfusion and nutrient
delivery to wound
• Accelerates growth of granulation tissue
• Decreases bacterial wound contamination
• Reduces bowel edema
• Application of mechanical stress to wounds
also increases proliferation and angiogenesis
28. VACUUM PACK :
Barker and colleagues in 1995 described another
technique,the vacuum pack, where a perforated plastic
sheet covers the viscera, sterile surgical towels are
placed in the wound, a surgical drain connected with a
continue negative pressure is placed on the towels and
all is covered by an airtight seal; the dressing should be
changed every 2–3days.The negative pressure allows a
collection of excess fluid and keeps constant tension on
the fascia
29. V.A.C PACK :
The vacuum pack was then modified with the
use of a polyurethane sponge and an
adjustable pump to set the negative pressure
named as V.A.C PACK with some advantages
like,
1. Reduced need for frequent dressing
changes
2. Increased vascularity of the wound
3. Decreased bacterial counts
4. Extended opportunity for definitive fascial
closure
30.
31. AB THERA :
Another modification of the system was
introduced in the AB-Thera with the use of
spider-like sponge that allow a better fluid
drainage and a better wound contraction.
32.
33. A recent modification of the Wittmann patch
was described by Dennis et al. in 2013
The underlying plastic sheet is sutured not
directly on the medial fascia but to the
underside of the abdominal wall, lateral to
the rectus sheath, using external bolsters on
the wound is applied a vacuum pack
dressing. With this technique they showed a
primary fascia closure in 100 % of the
patients.
34. Acosta described a combined technique using
VAC system with a polypropylene mesh
applied on the fascia edge to keep it in
traction and reported a fascia closure rate of
76.6 %
35. Another combined technique consist in the
use of the ABRA (ABDOMINAL
REAPPROXIMATION ANCHOR) system which
consist in a dynamic fascial tension device
with elastomers anchored to the abdominal
wall with plastic “button anchors” with the
VAC system with interesting results and a
reported fascial apposition rate of 83 %
36.
37. The main goal in open abdomen treatment
remains abdominal closure.
DEFINITIVE CLOSURE is to be attempted
within 8 days because a progressive
complication rate increase after the 8th day
of OA