Wittmann Patch

The Wittmann Patch is a temporary abdominal fascia prosthesis made of Velcro material that is used in cases in which the abdomen cannot be closed due to increased abdominal pressure or if several successive operations are planned (programmed relaparotomy , lavage stages , staged abdominal repair [STAR]) . The Wittmann Patch consists of two sterile plastic sheets that are reinforced with hooks and eyes for mutual anchoring.

Indications

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

• Abdominal compartment syndrome ,
• abdominal high pressure with impairment of vital organ function,
• Emergency treatment of abdominal trauma as an emergency measure up to the final intervention under stable circulatory conditions,
• diffuse peritonitis / intra-abdominal infection,
• acute infected necrosis of the pancreas in pancreatitis ,
• Intestinal ischemia or necrosis,
• massive intra-abdominal bleeding,
• Complications of a ruptured abdominal aortic aneurysm ,
• Complications of abdominal organ transplantation ,
• by edema endangered circulation to critical structures operated by extensive surgery.

Surgical technique

The Wittmann patch is roughly cut to the size of the abdominal wound opening. Then the individual leaves can be separated from each other and sewn onto the fascia . First, the soft loop leaf is sewn to the right abdominal fascia for a longitudinal cut or to the upper abdominal fascia for a transverse abdominal cut (preferably with a continuous nylon thread ) so that the loops point outwards and the smooth side lies on the contents of the abdominal cavity. Then the protruding free end must be pushed under the abdominal wall between the visceral and parietal peritoneum on the other side so that the entire intestine and the large mesh are covered. Now the stiffer hook blade is sewn onto the left or lower abdominal wall fascia so that the hooks point inward and can thus be pressed into the loop blade. The hook blade is also best attached to the abdominal wall fascia with a continuous suture with a nylon thread in wide stitches. The size of the deliberately oversized hook leaf can be cut back at the free edge so that it fits into the wound, i.e. is slightly smaller than the distance between the two fascia edges. The loop sheet rarely needs to be reduced in size. When closing the Velcro fastener, make sure that a small amount of residual tension is exerted on the fasciae so that the fasciae cannot retract sideways and shrink. On the other hand, enough pressure-relieving leeway must be left in order to avoid impairment of the organ functions of the kidneys, liver, lungs and circulation as well as the intestinal blood flow through the abdominal high pressure. Ideally, the Wittmann patch should be used under the conditions of the strict surgical strategy of programmed relaparotomy (staged abdominal repair).

history

The Wittmann Patch was invented by Dietmar H. Wittmann in 1987. It represents the end result of many years of research into several techniques of temporary abdominal closure, on which he has been working with colleagues from the University of Hamburg since 1978 in order to improve the prognosis of patients with advanced diffuse purulent peritonitis and organ failure due to increased intra-abdominal pressure. These included the Dynamic Retention Sutures (until 1982), the normal zipper purchased in a department store (until 1986) and the wide-hemmed slide fastener Ethizip. In 1988 Wittmann accepted a professorship at the Medical College of Wisconsin in the USA and continued to develop both the Velcro fastener and the Staged Abdominal Repair (STAR) surgical method. However, a prospective randomized study has not yet been possible because the number of cases is too small.

Individual evidence

1. ↑ Schein m., Ea: Source control: a guide to the management of surgical infections , Springer, 2003, p. 110, ISBN 3540429735 , here online
2. ↑ European Journal of Surgery , 1994; 25: 273-284