Change in Fascial Tension in Open Abdomens

Study Overview
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Brief Summary
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The goal of this observational study is to quantitatively measure the change in tension of the abdominal wall over time in subjects with open abdomens using a tensiometer.

Detailed Description
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For subjects undergoing damage control and decompressive laparotomy, surgeons frequently elect to keep the abdomen open in anticipation of multiple re-explorations or to prevent and/or treat abdominal compartment syndrome. The eventual goal is to definitively close the abdomen, including the fascia, when medically and surgically safe. The natural tendency with prolonged open abdomen is lateralization of the fascia, making closure of the fascia progressively more difficult as time passes. Though this is subjectively observed in the operating room as increased tension during fascial closure, there is no quantitative data describing how duration of open abdomen affects tension on the abdominal wall. This information has potential implications on the likelihood of successful primary closure, risk of dehiscence, and long term hernia development. This study aims to quantitatively measure the changes in tension of the abdominal wall over time in subjects with an open abdomen. A tensiometer will be used to measure the tension needed to approximate each side of the abdominal fascia to midline with each re-exploration until definitive abdominal wall closure.

Official Title
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The Change in Tension of the Abdominal Wall Tension in Open Abdomens

Conditions
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Abdominal Wall Defect, Incisional Hernia

Intervention / Treatment
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* Diagnostic Test: Abdominal tension measurement


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Adult patients with an open abdomen and plan for abdominal re-exploration Exclusion Criteria: patients under the age of 18 years pregnant patients patients who have no available Legally Authorized Representative to provide consent.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Patients with open abdomen<br>All non-pregnant adults with an open abdomen who are consentable or who have a legally authorized representative will have the tension on each side of their abdominal wall measured using a tensiometer at each abdominal exploration | Diagnostic Test: Abdominal tension measurement<br>* A tensiometer scale will be used to measure the tension needed to pull each side of the abdominal wall to midline<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in tension over time | The progressive change in abdominal wall tension will be analyzed | 1.5 years | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Subject factors affecting abdominal wall tension over time | Investigators will evaluate the relationship of BMI and age to the change in tension over time | 1.5 years | 
| Operative factors affecting abdominal wall tension over time | Investigators will evaluate the relationship of incision width and length, time in days that the abdomen was open, number of reoperations, and abdominal wall tension change over time. | 1.5 years | 
| Medical care factors affecting abdominal wall tension over time | Investigators will evaluate the relationship of volume and type of intravenous fluid administered, blood transfusion, diuresis, and vasopressor use and the change in abdominal wall tension over time. | 1.5 years |