Dynamic Fascial Closure and Botulinum Toxin: A Novel Alternative for the Definitive Closure of the Open and Contained Abdomen

Abstract

A case is presented in which a 54-year-old patient who, while being hospitalized for COVID19 pneumonia, suffered a septic shock due to acute Hinchey IV diverticulitis, for which Hartmann surgery was performed. He evolved with colonic ischemia, thus a total colectomy and open abdomen (OA) were performed.

The OA was handled with a vacuum system (VS) for 7 weeks, resulting in a type IIIa OA (Bjork) with a 26cm gap. Once the patient’s clinical conditions were given, we decided to initiate a dynamic closure (DC) with a polypropylene mesh mediated fascial traction system associated with injection of botulinum toxin (BT).

This strategy allowed a primary fascial closure (PFC) of the abdominal wall five weeks after starting the treatment, thus avoiding the morbidity of a second intention closure.