What complication can arise from using a VAC dressing over a burst abdomen?

Using a vacuum-assisted closure (VAC) dressing over a burst abdomen can lead to the formation of multiple bowel fistulae, particularly if there are existing factors such as bowel exposure or infection complicating the healing process. The negative pressure applied by the VAC dressing promotes wound healing by removing excess fluid and promoting granulation tissue formation; however, in the case of a burst abdomen, it can create a particularly challenging environment.

When the VAC is applied, the excessive suction can inadvertently interfere with the bowel's integrity, leading to potential complications. If there is underlying bowel ischemia or necrosis, or if the bowel was already compromised, the suction could contribute to tissue breakdown, resulting in fistulous tracts developing between the bowel and the skin or even between different segments of bowel. These fistulae can result from the conditions created by the VAC, such as increased pressure on weakened bowel tissue, which can exacerbate any existing pathology.

While infection, wound necrosis, and delayed healing are all potential complications associated with VAC dressings, the distinctive risk of developing multiple bowel fistulae is particularly notable in the setting of a burst abdomen, making it the most pertinent concern in this scenario.