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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

Year: 2026

Type: article

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.

Source: Scientific Reports

DOI: 10.1038/s41598-026-78639-3