“Acute postoperative open abdominal wall”: Nosological concept and treatment implications

Table 1 Groups and therapeutic options in complete intentional and unintentional acute postoperative open abdominal wall

Clinical/therapeuticscenario	Intestinal fistula	Non-adherentbowel loops	Free innerabdominal wall	Window ≤2-3 wk	Window> 2-3 wk	Therapeutic option
1	No	Yes	Yes	Yes Early definitive closure	-	Fascia to fascia closure. Continuous slowly absorbable monofilament suture, 4:1 rule
2	No	Partially	Partially	Yes Definitive early progressive closure	-	Vacuum-assisted wound closure and mesh traction or dynamic wound closure systems
3	No	No “Frozen abdomen”	No “Frozen abdomen”	-	Yes Delayed closure	Skin cover or after granulation skin graft “Planned” incisional hernia repair
4	Yes	-	-	-	-	Individualized

Table 2 Groups and therapeutic options in incomplete (intact skin) unintentional acute postoperative open abdominal wall

Clinical/therapeuticscenario	Intestinal fistula	Non-adherentbowel loops	Free innerabdominal wall	Window ≤2-3 wk	Window> 2-3 wk	Therapeutic option
2	No	Yes	Yes	Yes Early definitive closure	-	Fascia to fascia closure, 4:1 No retention sutures Mesh depending contamination Biologics doubtful
3	No	Partially	Partially	Yes definitive early progressive closure	-	Vacuum-assisted wound closure and mesh traction Or dynamic wound closure systems
4	No	No “Frozen abdomen”	No “Frozen abdomen”		Yes Delayed closure	Abdominal girdles Planned incisional hernia repair
5	Yes	-	-	-	-	Individualized
6 High surgical risk	-	-	-	-	-	Abdominal girdle