The Wittmann Patch is a temporary

abdominal fascia Abdominal fascia refers to the various types of fascia found in the abdominal region. Fascia is a sheet of connective tissue Connective tissue is one of the four primary types of animal tissue, a group of cells that are similar in structure, a ...

prosthesis for the planned open abdomen to ease the management of cases where the abdomen cannot be closed due to

abdominal compartment syndrome Abdominal compartment syndrome (ACS) occurs when the abdomen becomes subject to increased pressure reaching past the point of intra-abdominal hypertension (IAH). ACS is present when intra-abdominal pressure rises and is sustained at > 20 mmHg and ...

or because multiple further operations are planned (damage control repair CR. It consists of a sterile hook and a sterile loop sheet made from

propylene Propylene, also known as propene, is an unsaturated organic compound with the chemical formula . It has one double bond, and is the second simplest member of the alkene class of hydrocarbons. It is a colorless gas with a faint petroleum-like o ...

and

nylon Nylon is a family of synthetic polymers characterised by amide linkages, typically connecting aliphatic or Polyamide#Classification, semi-aromatic groups. Nylons are generally brownish in color and can possess a soft texture, with some varieti ...

History

The Wittmann Patch was invented by Dietmar H. Wittmann in 1987 while he was a professor of surgery at the

University of Hamburg The University of Hamburg (, also referred to as UHH) is a public university, public research university in Hamburg, Germany. It was founded on 28 March 1919 by combining the previous General Lecture System ('':de:Allgemeines Vorlesungswesen, ...

's School of Medicine in Hamburg Germany. Wittmann continued research on the Wittmann Patch fascia

prosthesis In medicine, a prosthesis (: prostheses; from ), or a prosthetic implant, is an artificial device that replaces a missing body part, which may be lost through physical trauma, disease, or a condition present at birth (Congenital, congenital disord ...

in the Department of Surgery at the

Medical College of Wisconsin The Medical College of Wisconsin (MCW) is a private medical school, pharmacy school, and graduate school of sciences in Milwaukee, Wisconsin, United States. The school was established in 1893 and is the largest research center in eastern Wisconsi ...

. The fascia prosthesis became commercially available in Europe in 1992 (HIDIH-Surgical) and in the US in 2000 (Starsurgical, Inc).

Synonyms

*Fascia Prosthesis, *Abdominal Fascia Prosthesis, *Temporary Abdominal Fascia Prosthesis, *Artificial Bur, *Bur Patch, *Abdominal Bur Closure (ABC-Patch)

Trade names

Wittmann Patch (Starsurgical, Inc., Burlington WI)

Indications

A Acute conditions *

Abdominal compartment syndrome Abdominal compartment syndrome (ACS) occurs when the abdomen becomes subject to increased pressure reaching past the point of intra-abdominal hypertension (IAH). ACS is present when intra-abdominal pressure rises and is sustained at > 20 mmHg and ...

Blunt abdominal trauma A blunt trauma, also known as a blunt force trauma or non-penetrating trauma, is a physical trauma due to a forceful impact without penetration of the body's surface. Blunt trauma stands in contrast with penetrating trauma, which occurs when an ...

* Penetrating abdominal trauma * Traumatic and non-traumatic intra-abdominal

hemorrhage Bleeding, hemorrhage, haemorrhage or blood loss, is blood escaping from the circulatory system from damaged blood vessels. Bleeding can occur internally, or externally either through a natural opening such as the mouth, nose, ear, urethra, ...

* Ruptured

abdominal aortic aneurysm Abdominal aortic aneurysm (AAA) is a localized enlargement of the abdominal aorta such that the diameter is greater than 3 cm or more than 50% larger than normal. An AAA usually causes no symptoms, except during rupture. Occasionally, abdo ...

Peritonitis Peritonitis is inflammation of the localized or generalized peritoneum, the lining of the inner wall of the abdomen and covering of the abdominal organs. Symptoms may include severe pain, swelling of the abdomen, fever, or weight loss. One pa ...

/ intra-abdominal infections *

Acute pancreatitis Acute pancreatitis (AP) is a sudden inflammation of the pancreas. Causes include a gallstone impacted in the common bile duct or the pancreatic duct, heavy alcohol use, systemic disease, trauma, elevated calcium levels, hypertriglyceridemia (w ...

/ infected pancreatic necrosis *

Bowel ischemia Intestinal ischemia is a medical condition in which injury to the large or small intestine occurs due to not enough blood supply. It can come on suddenly, known as acute intestinal ischemia, or gradually, known as chronic intestinal ischemia. The ...

B Chronic conditions * Chronic open abdomen with

fistula In anatomy, a fistula (: fistulas or fistulae ; from Latin ''fistula'', "tube, pipe") is an abnormal connection (i.e. tube) joining two hollow spaces (technically, two epithelialized surfaces), such as blood vessels, intestines, or other h ...

s * Chronic open abdomen without fistulas * Large ventral hernias with fistulas * Large ventral hernias without fistulas * Failed ventral hernia repairs with meshes C Prophylactically to avoid abdominal compartment syndrome * excessive peritoneal inflammation from abdominal organ transplantation * excessive peritoneal inflammation from major abdominal operations

Contraindications

The patch is not intended for permanent implantation.

Operative technique

The original bur as used by Wittmann consists of two sheets of the same size of 40 × 20 cm: * A softer loop sheet that covers omentum with its tissue-friendly back side – loops facing outwards * A harder hook sheet on top of the loop sheet – hooks facing inwards to be pressed into the loops The softer loop sheet is sutured to the right fascia using a running looped #1 Nylon suture. The stitches are 2 cm apart and 2 cm into the fascia and 1–2 cm into the bur to permit good perfusion between stitches. The sheet with loops facing outwards is then pushed between parietal and visceral peritoneum of the other side of the incision covering abdominal content. Then the harder hook sheet is similarly sutured to the left fascia, and hooks are gently pressed into the loops of the loop sheet. Generally, the hook sheet is trimmed to fit the size of the open abdomen wound. In case of the massive peritoneal hypertension both sheets cover the open space and the hook sheet does not need trimming to fit the wound opening.

Clinical benefits

* Use of the Wittmann Patch in patients allows for a significantly increased rate of delayed primary fascial closure after temporary abdominal closure when compared with a vacuum only closure or the use of a Bogota bag. * Use of the Wittmann Patch in combination with staged abdominal repair decreases mortality by 20% in patients with APACHE-II score of 20.

References

* (now Brit J. Surg.)

External links

openabdomen.org
Surgery