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Microvascular blood flow response in the intestinal wall and the omentum during negative wound pressure therapy of the open abdomen.

Hlebowicz, Joanna LU ; Hansson, Johan and Lindstedt Ingemansson, Sandra LU (2012) In International Journal of Colorectal Disease 27. p.397-403
Abstract
PURPOSE: Higher closure rates of the open abdomen have been reported with negative pressure wound therapy (NPWT) compared with other wound therapy techniques. However, the method has occasionally been associated with increased development of intestinal fistulae. The present study measures microvascular blood flow in the intestinal wall and the omentum before and during NPWT. METHODS: Six pigs underwent midline incision and application of NPWT to the open abdomen. The microvascular blood flow in the underlying intestinal loop wall and the omentum was recorded before and after the application of NPWT of -50, -70, -100, -120, -150, and -170 mmHg respectively, using laser Doppler velocimetry. RESULTS: A significant decrease in microvascular... (More)
PURPOSE: Higher closure rates of the open abdomen have been reported with negative pressure wound therapy (NPWT) compared with other wound therapy techniques. However, the method has occasionally been associated with increased development of intestinal fistulae. The present study measures microvascular blood flow in the intestinal wall and the omentum before and during NPWT. METHODS: Six pigs underwent midline incision and application of NPWT to the open abdomen. The microvascular blood flow in the underlying intestinal loop wall and the omentum was recorded before and after the application of NPWT of -50, -70, -100, -120, -150, and -170 mmHg respectively, using laser Doppler velocimetry. RESULTS: A significant decrease in microvascular blood flow was seen in the intestinal wall during application of all negative pressures levels. The blood flow was 2.7 (±0.2) Perfusion Units (PU) before and 2.0 (±0.2) PU (*p < 0.05) after application of -50 mmHg, and 3.6 (±0.6) PU before and 1.5 (±0.2) PU (**p < 0.01) after application of -170 mmHg. CONCLUSIONS: In the present study, we show that negative pressures between -50 and -170 mmHg induce a significant decrease in the microvascular blood flow in the intestinal wall. The decrease in blood flow increased with the amount of negative pressure applied. One can only speculate that a longstanding decreased blood flow in the intestinal wall may induce ischemia and secondary necrosis in the intestinal wall, which, theoretically, could promote the development of intestinal fistulae. We believe that NPWT of the open abdomen is a very effective treatment but could probably be improved. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
International Journal of Colorectal Disease
volume
27
pages
397 - 403
publisher
Springer
external identifiers
  • wos:000300507000016
  • pmid:21938450
  • scopus:84862608496
ISSN
1432-1262
DOI
10.1007/s00384-011-1317-2
language
English
LU publication?
yes
id
a73dece7-7e8b-4586-bdc4-3596f0ffb570 (old id 2168667)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/21938450?dopt=Abstract
date added to LUP
2011-10-03 13:06:55
date last changed
2017-01-01 07:35:48
@article{a73dece7-7e8b-4586-bdc4-3596f0ffb570,
  abstract     = {PURPOSE: Higher closure rates of the open abdomen have been reported with negative pressure wound therapy (NPWT) compared with other wound therapy techniques. However, the method has occasionally been associated with increased development of intestinal fistulae. The present study measures microvascular blood flow in the intestinal wall and the omentum before and during NPWT. METHODS: Six pigs underwent midline incision and application of NPWT to the open abdomen. The microvascular blood flow in the underlying intestinal loop wall and the omentum was recorded before and after the application of NPWT of -50, -70, -100, -120, -150, and -170 mmHg respectively, using laser Doppler velocimetry. RESULTS: A significant decrease in microvascular blood flow was seen in the intestinal wall during application of all negative pressures levels. The blood flow was 2.7 (±0.2) Perfusion Units (PU) before and 2.0 (±0.2) PU (*p &lt; 0.05) after application of -50 mmHg, and 3.6 (±0.6) PU before and 1.5 (±0.2) PU (**p &lt; 0.01) after application of -170 mmHg. CONCLUSIONS: In the present study, we show that negative pressures between -50 and -170 mmHg induce a significant decrease in the microvascular blood flow in the intestinal wall. The decrease in blood flow increased with the amount of negative pressure applied. One can only speculate that a longstanding decreased blood flow in the intestinal wall may induce ischemia and secondary necrosis in the intestinal wall, which, theoretically, could promote the development of intestinal fistulae. We believe that NPWT of the open abdomen is a very effective treatment but could probably be improved.},
  author       = {Hlebowicz, Joanna and Hansson, Johan and Lindstedt Ingemansson, Sandra},
  issn         = {1432-1262},
  language     = {eng},
  pages        = {397--403},
  publisher    = {Springer},
  series       = {International Journal of Colorectal Disease},
  title        = {Microvascular blood flow response in the intestinal wall and the omentum during negative wound pressure therapy of the open abdomen.},
  url          = {http://dx.doi.org/10.1007/s00384-011-1317-2},
  volume       = {27},
  year         = {2012},
}