Management of the open abdomen with dynamic closure of the abdominal wall. A case report

Background: Management of the open abdomen, particularly in the context of abdominal sepsis, continues to pose a significant surgical challenge. While static closure techniques remain widely used, dynamic methods such as mesh-mediated fascial traction combined with negative pressure therapy (NPT) have demonstrated improved outcomes in selected cases. Objective: To describe a dynamic closure technique using low-weight polypropylene mesh in conjunction with NPT, applied in a septic patient requiring open abdomen management. Case Report: A 72-year-old woman with a history of hypertension was admitted for a complicated parastomal hernia with signs of sepsis. She underwent sigmoidectomy with colostomy, followed by emergency reoperation due to generalized peritonitis. An open abdomen strategy was initiated, with repeated NPT cycles every 72 hours. On the fifth dressing change, dynamic fascial traction was performed by securing polypropylene mesh to the aponeurotic edges and applying progressive medial traction, while maintaining negative pressure at -120 mmHg. Results: Progressive reduction in the fascial gap was observed with each intervention, achieving closure without requiring permanent mesh implantation. No major complications occurred, and the patient remained free of wound dehiscence or incisional hernia at discharge. Conclusion: The combination of mesh-mediated fascial traction and NPT is a viable option for abdominal wall closure in septic patients with open abdomen. This technique may promote early closure, limit morbidity, and reduce long-term sequelae when applied appropriately. Keywords: Open abdomen, negative pressure therapy, dynamic closure, abdominal sepsis, mesh traction, abdominal wall reconstruction.