The Wittmann Patch is a temporary abdominal fascia prosthesis for the planned open abdomen to ease management of cases where the abdomen cannot be closed due to abdominal compartment syndrome or because multiple further operations are planned (damage control repair [DCR]). It consists of a sterile hook and a sterile loop sheet made from propylene and nylon.
Contents
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)
Indications
A Acute conditions
B Chronic conditions
C Prophylactically to avoid abdominal compartment syndrome
Contraindications
The patch is not intended for permanent implantation.
Operative technique
The original bur a used by Dr. Wittmann consists of two sheets of the same size of 40 × 20 cm:
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
History
The Wittmann Patch was invented by Dietmar H. Wittmann, MD, PhD, FACS in 1987 while being a Professor of Surgery at the University of Hamburg, School of Medicine in Hamburg Germany. Dr. Wittmann continued research on the Wittmann Patch fascia prosthesis in the Department of Surgery at the Medical College of Wisconsin.The fascia prosthesis became commercially available in Europe in 1992 (HIDIH-Surgical) and in the USA in 2000 (Starsurgical, Inc)