Witman Patch Surgery
Closing the open abdomen: improved success with Wittmann Patch staged Care, Department of Surgery, University of Alabama at Birmingham, Birmingham.
Examples of Wittmann Patch being used to treat and close abdominal wounds, as described in the clinical literature.
The following photos illustrate the Wittmann Patch application as described in the use instructions and in the clinical literature by surgeons using it together with an adhesion preventing barrier.
The Wittmann Patch is also added to negative pressure dressing systems when these systems alone are not enough to achieve fascial closure. The Wittmann Patch helps prevent lateral retraction and maintain abdominal domain. As swelling decreases, the fascial edges are gradually pulled together at dressing changes until able to close.
Click on any image below to enlarge it.
Attaching Velcro -like Wittmann Patch to fascial borders with a running non-absorbable suture.
Adhesion preventing barrier sterile X-Ray cassette cover with fenestrations shown as in references 1 2 4 tucked between bowel and peritoneum out to lateral gutters.
Adhesion preventing barrier in position under the abdominal wall, over the abdominal viscera, and into the deep lateral gutters of the abdominal cavity 1 2.
Loop sheet tucked under the opposing fascia and overlapped with the hook sheet to form a secure closure.
Overlapping hook sheet trimmed and adjusted with a slight tension to help prevent lateral retraction and maintain abdominal domain.
Drain placement between layers of gauze over Wittmann Patch.
Alternatively, see pictures below using negative pressure Abdominal V.A.C system.
Application of negative pressure to remove fluids.
Negative pressure dressing change using Abdominal V.A.C. system. Adhesion barrier is beneath the Wittmann Patch and V.A.C. sponge dressing is on top.
V.A.C sponge on top of Wittmann Patch with adhesive skin drape and suction hooked to negative pressure unit.
As abdominal swelling decreases, the fascial edges are pulled closer together. The Wittmann patch is opened at least once every 24 to 36 hours
for dressing changes, procedures, inspections, and reapproximations.
When the two fascial edges are close enough, the remaining patch material is removed and the abdominal wall closed fascia-to-fascia.
Surgical pictures 1, 9, 10 courtesy of Mauricio Miglietta, D.O.
Surgical pictures 2-8, 11 courtesy of Richard Fantus, M.D.
The Wittmann Patch is indicated for temporary bridging of abdominal wall Overview Surgical Technique Surgical Technique Video Instructions for Use.
Wittmann Patch Surgical Technique Video. Temporary Abdominal Closure Techniques: The Wittmann Patch was presented by Richard J. Fantus, M.D., FACS.
The use of the Wittmann Patch facilitates a high rate of fascial closure in severely injured trauma patients and critically ill emergency surgery patients. Tieu BH 1.
The Wittmann Patch is a temporary abdominal fascia prosthesis for the Dietmar H. Wittmann, MD, PhD, FACS in 1987 while being a Professor of Surgery at the Indications - Contraindications - Operative technique - Clinical benefitsThe use of the Wittmann Patch facilitates a high rate of www.ncbi.nlm.nih.gov/SimilarNational Center for Biotechnology Information.
