{"id":19,"date":"2015-08-15T14:03:26","date_gmt":"2015-08-15T20:03:26","guid":{"rendered":"http:\/\/drtomasibarra.com\/blog\/?p=19"},"modified":"2024-12-30T16:35:32","modified_gmt":"2024-12-30T22:35:32","slug":"novel-technique-to-improve-primary-fascial-closure-rates-of-the-open-abdomen","status":"publish","type":"post","link":"https:\/\/drtomasibarra.com\/blog\/index.php\/2015\/08\/15\/novel-technique-to-improve-primary-fascial-closure-rates-of-the-open-abdomen\/","title":{"rendered":"Novel technique to improve primary fascial closure rates of the open abdomen"},"content":{"rendered":"

Comment to: Chemical components\u00a0separation with botulinum toxin A: a\u00a0novel technique to improve primary fascial\u00a0closure rates of the open abdomen by\u00a0Zielinski et al.T. R. Ibarra-Hurtado & C. M. Nu\u00f1o-Guzm\u00e1n<\/strong><\/p>\n

To the Editor\u00a0Descarga carta al editor<\/a><\/p>\n

We read with great interest the article by Dr. Zielinski et al.<\/p>\n

[1 ]. The authors presented a retrospective review of their\u00a0experience with botulinum toxin A (BTA) (Botox ,<\/p>\n

Allergan, Inc. Irvine, CA 92612) application into the lateral<\/p>\n

abdominal wall musculature of open abdomen (OA)<\/p>\n

patients, in order to describe the BTA injection technique<\/p>\n

and to determine its effects on the abdominal wall after<\/p>\n

OA, which is named by the authors \u2018\u2018chemical components<\/p>\n

separation technique.\u2019\u2019 A total of 18 patients were included.<\/p>\n

Indications for OA management included bowel viability<\/p>\n

(39 %), shock (33 %), feculent contamination (17 %), and<\/p>\n

loss of abdominal domain (6 %). A median of 3 serial<\/p>\n

abdominal explorations (1\u20138) after the initial OA management<\/p>\n

was required. Temporary abdominal closures with<\/p>\n

negative pressure dressings were applied. A primary fascial<\/p>\n

closure rate of 83 %, partial fascial closure rate of 6 %, and<\/p>\n

planned ventral hernia rate of 11 % are reported. The<\/p>\n

authors reported a BTA injection within 24 h of the initial<\/p>\n

OA procedure in 50 % of the cases, achieving an 89 %<\/p>\n

primary fascial closure rate, and 11 % partial fascial closure<\/p>\n

rate of these patients. An overall 67 % complication<\/p>\n

rate was found, with fascial dehiscence in 11 %.<\/p>\n

The clinical effect of botulinum toxin has been demonstrated<\/p>\n

as early as day 3 after intramuscular injection<\/p>\n

with a maximum effect at 2 weeks [2 ]. In a prospective<\/p>\n

study of twelve patients with abdominal wall hernia secondary<\/p>\n

to OA management, the maximal effect of BTA<\/p>\n

(Dysport, IPSEN, France) was observed at 3 weeks after<\/p>\n

injection. A significant reduction in the transverse hernia<\/p>\n

defect diameter was achieved [3 ]. The high overall primary<\/p>\n

fascial closure rate in patients with BTA injection within<\/p>\n

24 h of the initial OA procedure achieved by Dr. Zielinski<\/p>\n

et al. [1 ] is particularly interesting.<\/p>\n

We would like to ask Dr. Zielinski et al., at what time<\/p>\n

were the remaining patients injected with BTA and the<\/p>\n

time at which abdominal closure was performed.<\/p>\n

Dr. Zielinski et al. reported 6 injection sites on the<\/p>\n

abdominal wall: right\/left subcostal; right\/left anterior<\/p>\n

axillary; right\/left lower quadrants. Injection of 16.6 units<\/p>\n

of the BTA solution for each of external oblique, internal<\/p>\n

oblique, and transverse muscles is performed at each of<\/p>\n

the 6 injection sites (50 units per injection site, total of<\/p>\n

300 units). Our group reported BTA application at 10<\/p>\n

sites: two sites at the middle axillary line between costal<\/p>\n

margin and iliac crest level, and three sites between<\/p>\n

anterior axillary line and middle clavicular line between<\/p>\n

costal margin and iliac crest level, with similar sites on<\/p>\n

the opposite side, for a total of 50 units per injection site<\/p>\n

dosage [3 ].<\/p>\n

A considerable range of 20\u201375 % of surviving patients<\/p>\n

managed with OA will have the abdominal fascia closed<\/p>\n

prior to discharge, while the remaining patients may<\/p>\n

undergo abdominal wall reconstruction afterward [4 ]. With<\/p>\n

no doubt, BTA injection will constitute an important<\/p>\n

adjuvant to abdominal wall closure in patients under OA<\/p>\n

management, planned ventral hernia or large abdominal<\/p>\n

wall hernias.<\/p>\n

 <\/p>\n

 <\/p>\n","protected":false},"excerpt":{"rendered":"

Comment to: Chemical components\u00a0separation with botulinum toxin A: a\u00a0novel technique to improve primary fascial\u00a0closure rates of the open abdomen by\u00a0Zielinski et al.T. R. Ibarra-Hurtado & C. M. Nu\u00f1o-Guzm\u00e1n<\/p>\n","protected":false},"author":3,"featured_media":11,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2],"tags":[],"class_list":["post-19","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-articulos"],"_links":{"self":[{"href":"https:\/\/drtomasibarra.com\/blog\/index.php\/wp-json\/wp\/v2\/posts\/19","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/drtomasibarra.com\/blog\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/drtomasibarra.com\/blog\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/drtomasibarra.com\/blog\/index.php\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/drtomasibarra.com\/blog\/index.php\/wp-json\/wp\/v2\/comments?post=19"}],"version-history":[{"count":3,"href":"https:\/\/drtomasibarra.com\/blog\/index.php\/wp-json\/wp\/v2\/posts\/19\/revisions"}],"predecessor-version":[{"id":31,"href":"https:\/\/drtomasibarra.com\/blog\/index.php\/wp-json\/wp\/v2\/posts\/19\/revisions\/31"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/drtomasibarra.com\/blog\/index.php\/wp-json\/wp\/v2\/media\/11"}],"wp:attachment":[{"href":"https:\/\/drtomasibarra.com\/blog\/index.php\/wp-json\/wp\/v2\/media?parent=19"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/drtomasibarra.com\/blog\/index.php\/wp-json\/wp\/v2\/categories?post=19"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/drtomasibarra.com\/blog\/index.php\/wp-json\/wp\/v2\/tags?post=19"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}