Authors: U Zingg A Platz
Publish Date: 2009/03/04
Volume: 33, Issue: 6, Pages: 1334-1334
Abstract
We thank Dr Perathoner and colleagues for their interest in our article 1 The median time interval between the first surgery and the application of the vacuumassisted closure VAC system was 7 range 0–17 days In three patients the VAC system was applied at time of the primary operation in 14 patients at time of the first revision median 5 days after the primary surgery range 1–12 days and in 13 patients at time of the second revision median 11 days after primary surgery range 5–17 days The primary outcome of our study was closure of the fascia and we did not evaluate or mention the time of use of subcutaneous VAC systems We are convinced that the crucial steps of treatment are mostly finished when the intraabdominal sepsis is resolved and the fascia is closed or when an inlay mesh could be implanted The treatment of the resulting subcutaneous wounds was partially performed in an outpatient setting and the time intervals would probably not reflect the fastest approach to complete wound closureWe agree with the observation of Perathoner et al that the VAC system alone is insufficient to avoid fascial retraction The concept of dynamic sutures as an adjuvant to avoid fascial retraction is interesting and needs further assessment in randomized trials The use of additional sutures on the fascial edges may have the disadvantage of further reducing the quality of the fascia especially in patients who need multiple revisions Therefore in our view the most important factor to ensure primary closure is early stepwise closure of the fasciaThe VAC system has improved the treatment of patients with abdominal sepsis and provides a safe treatment option with low systemrelated morbidity However as Perathoner and colleagues mentioned there is a need for further trials with larger cohort numbers and clear definitions on abdominal sepsis to evaluate the optimal use of the VAC system in these critically ill patients
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