Low-cost dynamic fascial traction using serial Bogota bag tightening in open abdomen management: A prospective randomized study

Table 3 Innovative techniques for dynamic fascial traction for the open abdomen

Ref.	Study design and population	Technique	Key results	Remarks
Fung et al[6]	Retrospective multicenter case series; 9 patients in critical care units (including sepsis and bowel ischemia); 12 received concomitant NPWT and 8 had Bogota bag coverage	Fasciotens™ device providing vertical sustained traction using a stand with suspended thread retainer; fascial sutures tightened using screw mechanism	Mean OA duration: 3 days; mean initial fascial gap: 15 cm with significant reduction to 10 cm (P = 0.0081); mean time to DFC: 7 days; comparable outcomes in septic and non-septic OA (7.5 days vs 7 days); two long-term incisional hernias; no procedure-related mortality	High cost (approximately ₹3 Lakh per unit); heterogeneous etiologies; limited applicability due to simultaneous use of multiple techniques
Dohmen et al[18]	Retrospective case series; 9 critically ill patients (including sepsis and bowel ischemia)	Fasciotens™ device with vertical sustained traction	Mortality: 3 patients; mean OA procedures: 3 ± 1; mean time to DFC: 9 ± 3 days; 76% reduction in fascia-to-fascia gap; intra-abdominal pressure reduced from 31 ± 8 mmHg to 8.5 ± 2 mmHg; skin irritation and blisters in 3 cases	High cost (~₹3 Lakh per unit)
Mones et al[19]	Retrospective case series; 9 patients (2 vascular, 7 abdominal surgery)	Fasciotens™ device with vertical sustained traction	DFC achieved in 7 of 9 cases; mean OA duration: 9.6 ± 3.8 days; mean initial fascial gap: 14.2 ± 4.0 cm; mean time to DFC after VMMFT: 6.2 ± 3.5 days; no method-related complications	High cost (~₹3 Lakh per unit); heterogeneous patient population
Pereira-Warr et al[20]	Retrospective case series; 8 patients with sepsis, bowel ischemia, or bowel edema	Viscera covered with perforated plastic sheet; suction drain tubing sutured longitudinally to fascia on both sides; additional drain passed circumferentially to provide gradual fascial tightening	Mean OA procedures: 2.4; mean initial fascial gap: 16.8 cm; mean time to DFC: 9.1 days; mean ICU stay: 43.6 days; no 30-day mortality or major complications	Low-cost, bedside, feasible technique; fenestrated drains obviate need for NPWT; DFC feasible when gap is 3-7 cm; stomas do not interfere with closure
Dennis et al[21]	Retrospective case series; 32 patients (predominantly trauma follow-up cases)	Modified Wittmann patch with indigenous transabdominal wall traction device anchored to lateral abdominal wall; medial traction achieved by tightening external bolsters; NPWT used concomitantly	Mean initial fascial gap: 18.5 cm × 30.5 cm; mean OA procedures: 2.2; mean time to DFC: 18.2 days; mean reduction in wound size: 9.8 cm (51.4%); ECF in 4 cases; no incisional hernia or dehiscence; no procedure-related mortality	Cost-effective and indigenous; requires repeated anesthesia and operating-room interventions; intensive training required; DFC endpoint of 2 cm used
Jo Svetanoff et al[22]	Retrospective case series; 3 pediatric patients	Bedside techniques including reinforced silastic silos sutured to fascia with thick polypropylene or polyethylene sutures; DFT achieved using 20-pound weights in two patients; botulinum toxin, horizontal mattress sutures, and NPWT used in one patient	Initial fascial gap: 10-18 cm; OA procedures: 2-3; DFC achieved in 7-10 days in all cases	Bedside tightening feasible due to polyethylene (Ethibond™) sutures; pediatric patients require tailored approaches due to lower abdominal volume and frequent ACS

OA: Open abdomen; DFC: Definitive fascial closure; IAP: Intra-abdominal pressure; NPWT: Negative pressure wound therapy; ICU: Intensive care unit; ACS: Abdominal compartment syndrome; ECF: Enterocutaneous fistula.