Noninvasive fascial traction improves primary fascial closure and reduces the incidence of incisional hernia in open abdomens

BACKGROUND: Open abdomens (OA) remain a major source of morbidity and mortality in trauma and emergency general surgery (EGS). Fascial traction has been shown to improve primary closure of the OA. However, reports on the incidence of incisional hernias (IH) after OA closure are scarce. The purpose of this study was to evaluate factors associated with primary fascial closure and the development of IH in OA managed with two different methods. METHODS: A retrospective cohort study of all OA patients with midline laparotomies for trauma and EGS (January 2019 to October 2024) in a level 1 trauma center. Patients were divided into two groups, those treated with a noninvasive fascial traction device in conjunction with negative pressure wound therapy (NPWT) system (AbClo + AbThera) and those treated only with NPWT system. Outcomes included fascial width at closure attempt, primary closure (fascia-to-fascia), and incidence of IH. Univariate regression models were performed to identify factors associated with IH. RESULTS: A total of 143 patients met inclusion criteria, 85 (59.4%) used AbClo + AbThera and 58 (40.6%) AbThera only. Primary closures were 94.1% (AbClo + AbThera) versus 72.4% (AbThera only); absolute risk difference 21.7% (95% CI: 9.5-34.8) and relative risk 1.30. Fascial widths were narrower in successful closures 6.0 versus 11.9 cm and in AbClo + AbThera (4.0 cm) versus AbThera alone (10.2 cm); 61.3% reduction in gap size; (all P<0.001). IH cumulative incidences were 28.8% (12-mo), 36.4% (24-mo). The 12-month incidence was lower with AbClo + AbThera (14.1%) versus AbThera alone (63.1%), P<0.0001. Fascia width ≥10 cm increased hernia risk (hazard ratio=3.71). The relative risk reduction in hernia risk was 60.7% with AbClo + AbThera; absolute risk reduction 24.8. CONCLUSIONS: Management of OA with AbClo + AbThera improved fascial closure and reduced incisional hernias compared AbThera alone. (J Trauma Acute Care Surg. 2026;00: 000-000. Copyright © 2026 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Association for the Surgery of Trauma.). LEVEL OF EVIDENCE: Retrospective Comparative Study; Level IV.