Wittmann Patch

The Wittmann Patch is a temporary Bauchfaszienprothese from Velcro material that is used in cases where the stomach due to abdominal pressure increase can not be closed, or if several successive operations are planned ( Programmed relaparotomy, Etappenlavage, Staged Abdominal Repair [ STAR ] ). The Wittmann Patch consists of two sterile plastic sheets that are reinforced with hook and eye to the mutual anchoring.

Indications

The Wittmann Patch is not intended for permanent implantation. Examples of its possible applications are:

  • Abdominal compartment syndrome,
  • Abdominal hypertension with impairment of vital organ function,
  • Emergency, regular supplies of abdominal trauma as an emergency measure until the final intervention under stable circulatory conditions,
  • Diffuse peritonitis / intra -abdominal infection,
  • Acute infective necrosis of the pancreas in pancreatitis,
  • Intestinal ischemia or bowel necrosis,
  • Massive intra-abdominal bleeding,
  • Complications of a ruptured abdominal aortic aneurysm,
  • Complications of abdominal organ transplantation,
  • By edema vulnerable blood flow to critical structures operated on following extensive surgery.

Surgical Technique

The Wittmann Patch is roughly cut to the size of the stomach wounds opening handle. Then, the individual sheets can be separated from each other and are each sewn to the fascia. First, the soft sling sheet is sewn in the longitudinal section of the right or the cross tummy cut on the upper Abdominalfaszie (best with a continuous nylon thread ) is that the loops face outwards and the smooth side to lie on the abdominal cavity contents. Then the protruding free end should be inserted under the abdominal wall between visceral and parietal peritoneum of the other side, so that the entire intestine and the large network are hidden. Now, the rigid hook sheet is sewn on the left or lower Bauchdeckenfaszie that the hook can thus be pressed into the loop sheet and facing inward. Also the hook blade is best with a continuous suture with a nylon yarn in large stitches mounted on the Bauchdeckenfaszie size deliberately oversized hook sheet can be cut back at the free edge to such an extent that it fits into the wound, thus is somewhat smaller than the distance between the two Faszienrändern. The sling blade rarely needs to be reduced. When you close the Velcro should make sure that a small remaining pull is exerted on the fascia, so that the fascia does not retract sideways and can shrink. On the other hand, sufficient pressure relieving scope must be left in order to avoid impairment of the executive functions of the kidney, liver, lungs and circulatory system as well as the intestinal blood flow through the abdominal hypertension. Ideally, the Wittmann patch under the terms of strict operation strategy of programmed relaparotomy ( Staged abdominal repair) should be used.

History

The Wittmann Patch was invented by Dietmar H. Wittmann in 1987. It represents the end result of many years of research several techniques of fast- rare abdominal closure, on which he worked with colleagues from the University of Hamburg since 1978 to improve the prognosis of patients with late-stage diffuse purulent peritonitis and organ failure by intra -abdominal pressure increases. These included the Dynamic Rentention Sutures (up to 1982), the normal acquired in the department store zipper ( to 1986 ), and the slide top breitsäumige Ethizip. In 1988 Wittmann a professor at the Medical College of Wisconsin in the United States and developed both the Velcro and the surgical method Staged abdominal repair (STAR) away. However, a prospective randomized trial was not possible due to small numbers of cases.

Abdomen
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