Background
Dr. Guidry, Tulane Trauma Surgeon, informed our team of a need to improve delayed abdominal closure.
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What's Delayed Abdominal Closure?
When a person experiences trauma to the abdomen, it often causes internal bleeding and swelling. The quickest and most efficient method to identify the source of damage causing the bleeding/swelling/injury is to make an incision directly down the middle of the stomach but the internal pressure often prevents the stomach from being closed again. Imagine a suitcase that was packed too tight and then when you unpack and repack it, it doesn't close again. Thus the need to have a device that can allow the stomach to close slowly over time.
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Current techniques to provide delayed closure often lead to complications:
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Sepsis
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Multiple Organ Failure
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Death
Current Methods
ABThera™ :
Pros:
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Stretches skin/fascia to promote closure
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Negative Pressure treatment
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Cons:
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No method of closure
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Traumatizing to patients to see through patch
ABRA :
Pros:
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Can manually tighten
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Cons:
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Damages healthy tissue
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Needs constant maintenance
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Subjective pressure monitoring
Whittmann Patch™ :
Pros:
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Allows adjustable tightening
Cons:
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Damages healthy surrounding fascia
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Requires OR time for tightening
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Requires cutting excess tissue to remove for closure
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Subjective monitoring
Skin/Mesh Grafts :
Pros:
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Allows option when other methods won't work
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Allows a slightly quicker recovery/hospital stay
Cons:
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Traumatizing to patients
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Typically induces hernias
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Requires patient to have another surgery 1 year later
Needs Statement
This research led to the development of our needs statement:
Surgeons need a way to prevent complications while providing delayed reconnection of the abdominal wall post damage control surgeries.
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This led to the development of Ab Closure and our device.
Ab Closure Components
Intra-Abdominal Pressure Sensor:
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A Foley bladder catheter that reads abdominal pressure being placed on the bladder
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Motor:
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Currently a toy motor, informed by an arduino and used to turn the turning mechanism attached to the mesh to pull the two sides of the fascia together
Turning Mechanism:
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Sutures passed through center and through both sides of the mesh and connects to the motor and reels up the sutures
Mesh Implant:
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Sutured into both sides of fascia, resorbable, ovine mesh to prevent damage to tissue if turning mechanism needs to be replaced or moved locations new sutures aren't being made in tissue but in mesh