These factors all have a considerable cost element so early but safe abdominal closure is the best outcome. The most commonly cited objection to the use of NPWT TAC is a perceived increase in fistula formation. The rate of fistula formation in the current study of 5% was similar to that derived from the published studies of 3%. It is possible that these relatively #EPZ015938 randurls[1|1|,|CHEM1|]# low levels of fistula formation are observed in this specific population of open abdomen patients [2, 21] and that higher incidence of de novo fistula formation may occur in ‘high risk’ subsets

of patients i.e. those with more advanced grade of open abdomen (grade 3 or 4), sepsis, or in wounds where a bowel anastomosis following bowel surgery is present or where there is a delay or failure to achieve fascial closure. In fact where concern has been expressed by several commentators [22–24] the patients described tend to be ‘high risk’. The potential link between Avapritinib NPWT and fistula formation

has been disputed by others [25] including in a systematic review [26]. More evidence is needed to determine whether use of NPWT on grade 3 or 4 open abdomen is effective and whether an increased risk of fistulisation is indeed observed as a result of therapy in this sub-population. With regard to the current study, one drawback is the relatively low sample size, which may not accurately reflect the true incidence of fistula formation in these wounds. One variable not assessed in the systematic review was the level of negative pressure used in each study. This is reported in only one study where the relatively high level of -175 mmHg was used [13]. Use of high levels of negative Oxalosuccinic acid pressure is thought to a potential risk factor for increased fistula formation but the present analysis is not able to clarify this assertion. Wider adoption of the published classification system is needed when reporting outcomes on open abdomen patients in order to help clarify these and other issues. Conclusion Application

of an alternative NPWT TAC system, when applied to trauma patients with grade 1 and 2 open abdomens (Bjorck et al. classification) [7] is safe and effective resulting in a high rate of fascial closure rate (65% intent-to-treat) and relatively low rate of complications. These values are similar to those presented in the published literature. Wider adoption of the published classification system is needed when reporting outcomes on open abdomen patients. Acknowledgements Hussein Dharma and Alison Wraith (employees of Smith & Nephew) carried out data management and statistical analysis. S&N (the funding body) contributed to study design and provided statistical evaluation and medical writing expertise. The reporting of the study is believed to be impartial and scientific in its approach. References 1.