Vertical mesh-mediated fascial traction is associated with higher fascial closure rates than vacuum-assisted wound closure with mesh-mediated traction in open abdomen therapy

Abstract Open abdomen treatment (OAT) is a critical surgical strategy for managing severe intra-abdominal conditions. Early definitive fascial closure (DFC) reduces complications and mortality. While the vacuum-assisted wound closure with mesh-mediated fascial traction (VAWCM) technique is considered the current standard, novel methods such as vertical mesh-mediated fascial traction (VMMFT) with devices like Fasciotens® Abdomen offer a promising alternative. This retrospective, registry-based, propensity score–matched cohort study compared fascial closure outcomes between VAWCM and VMMFT in patients undergoing OAT, utilizing data from the European Hernia Society Open Abdomen Registry (2015–2024). Patients were matched based on sepsis at OAT initiation and initial fascial defect width. Statistical analyses included descriptive statistics, Chi-square and Mann–Whitney U tests, and logistic regression. Of 1119 OAT cases, 39 (3.5%) received VMMFT and 675 (60.3%) VAWCM. After matching, each cohort included 28 patients. In the matched cohorts, higher DFC rates were observed with VMMFT than with VAWCM in both the ITT-like (89.3% vs. 60.7%; p = .01) and PP-like analyses (100.0% vs. 69.6%; p = .01). Logistic regression in the matched cohort showed an association between VMMFT and higher odds of fascial closure (OR 5.39, 95% CI 1.31–22.25; p = .02), although the confidence interval was wide. ICU stay and ventilation duration were longer in the VMMFT group, while enteroatmospheric fistula occurred in 0% versus 10.7% of patients, respectively (p = .08). In this retrospective registry-based analysis, VMMFT was associated with higher fascial closure rates compared with VAWCM. Given the limited number of VMMFT cases, wide confidence intervals, and residual imbalance after propensity-score matching, these findings should be interpreted as observational, exploratory, and hypothesis-generating rather than confirmatory. Larger prospective studies using standardized treatment protocols are required to confirm this association. Trial registration: German Clinical Trials Register (DRKS00037753), registered on 2 June 2026.

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Journal
Scientific Reports
Published
2026-11-11
DOI
https://doi.org/10.1038/s41598-026-78639-3
Primary Topic
Abdominal Surgery and Complications
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article
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article

Vertical mesh-mediated fascial traction is associated with higher fascial closure rates than vacuum-assisted wound closure with mesh-mediated traction in open abdomen therapy

Tobias Keck, Till Stummeyer, Eugen Malamutmann, Dirk Scheller et al.
Scientific Reports
Abdominal Surgery and Complications
article

Vertical mesh-mediated fascial traction is associated with higher fascial closure rates than vacuum-assisted wound closure with mesh-mediated traction in open abdomen therapy

Tobias Keck, Till Stummeyer, Eugen Malamutmann, Dirk Scheller, Charlotte Röhrborn, Omaira Rodríguez, Guillaume Passot, Jorn Maroske, Lope Estévez Schwarz, Vasilena Chobanova, Lisbeth Huillca, Barbora East, Christoph Güsgen, Jonas Dohmen, Orestis Ioannidis, Martin W. von Websky, Mauro Zago, Maksims Mastalers, Louise Zinck Mogensen, Uzma Soomro, Ioannis Mamaloudis, Frederik Christiaan Berrevoet, Christoph Ulmer, Ulf Petersson, Krevosha Pillay, Robleh Hassan Farah, Oliver Fuckert, Jörg Salewski, David Nešpor, Ana Marta Pereira, Benny Kölbel, Wolfgang Tillenburg, Julie De Deken, Jens Plambeck, Alp Ömer Cantürk, Alessia Malagnino, Stefano Piero Bernardo Cioffi, Tim Oliver Vilz, Sebastian Schaaf, João Louro, Kristina Lenz, Eva Barbosa, Johan F. Lock, Anette Søgaard, Thomas Mones, Julia Bertram, Roxana Livadariu, Badri Gogia, Jan Romih, Sandrina Dascalescu, Spiros Delis, Daniel Sánchez López, Antonio Ferreira, Thomas Auer, Eva Deerenberg, Zina Lyubenova, Christian Benignus, Christoph Schwaiger-Hengstschläger, Fabian Schoen, Ioannis Triantafyllidis, Georgios Konstantoudakis, Lena Wimmert, Jolanda Fandiño, Luise Kunsch, Thomas Rhys, Mohamed Hamouda Elsayed Ahmed Ali Elkasaby, Dirk Bulian, Benjamin Nickel, Ines Werner, Athanasios Marinis, Domantas Joudis, Hans Friis-Andersen, Ashraf Elmetwally, David Ellebrecht, Yamen Shaheen, Anna Kurpierz, Christian Beltzer, Leila Telan, Marius Kivillis, Humberto Gustavo Martinez Martinez, Arina Pothas, Andrea Tognoni, Jorge Estrada, Mudassar Ghazanfar, Paulo Ferreira, Arnulf G. Willms, Niels Harlaar, Haseeb Khan, Christian Debus, Swapnil Musale, Nikita Marathe, Hima Yarlagadda, Joana Correia, Gregor A. Stavrou, The EHS Open Abdomen Study Group
article en

Abstract

Abstract Open abdomen treatment (OAT) is a critical surgical strategy for managing severe intra-abdominal conditions. Early definitive fascial closure (DFC) reduces complications and mortality. While the vacuum-assisted wound closure with mesh-mediated fascial traction (VAWCM) technique is considered the current standard, novel methods such as vertical mesh-mediated fascial traction (VMMFT) with devices like Fasciotens® Abdomen offer a promising alternative. This retrospective, registry-based, propensity score–matched cohort study compared fascial closure outcomes between VAWCM and VMMFT in patients undergoing OAT, utilizing data from the European Hernia Society Open Abdomen Registry (2015–2024). Patients were matched based on sepsis at OAT initiation and initial fascial defect width. Statistical analyses included descriptive statistics, Chi-square and Mann–Whitney U tests, and logistic regression. Of 1119 OAT cases, 39 (3.5%) received VMMFT and 675 (60.3%) VAWCM. After matching, each cohort included 28 patients. In the matched cohorts, higher DFC rates were observed with VMMFT than with VAWCM in both the ITT-like (89.3% vs. 60.7%; p = .01) and PP-like analyses (100.0% vs. 69.6%; p = .01). Logistic regression in the matched cohort showed an association between VMMFT and higher odds of fascial closure (OR 5.39, 95% CI 1.31–22.25; p = .02), although the confidence interval was wide. ICU stay and ventilation duration were longer in the VMMFT group, while enteroatmospheric fistula occurred in 0% versus 10.7% of patients, respectively (p = .08). In this retrospective registry-based analysis, VMMFT was associated with higher fascial closure rates compared with VAWCM. Given the limited number of VMMFT cases, wide confidence intervals, and residual imbalance after propensity-score matching, these findings should be interpreted as observational, exploratory, and hypothesis-generating rather than confirmatory. Larger prospective studies using standardized treatment protocols are required to confirm this association. Trial registration: German Clinical Trials Register (DRKS00037753), registered on 2 June 2026.

Scientific ReportsVol. 16(1)
University of Bonn (DE), Universidade do Porto (PT), Ghent University Hospital (BE), Alessandro Manzoni Hospital (IT), Universitätsklinikum Aachen (DE), Maria Hilf Krankenhaus (DE), Bundeswehrzentralkrankenhaus Koblenz (DE), Bundeswehr (DE), Aziende Socio Sanitarie Territoriali di Lecco (IT), RWTH Aachen University (DE)
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Abdominal Surgery and Complications
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