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

The use of a vacuum-assisted closure (VAC) dressing over a burst abdomen, or an abdominal wound that has dehiscenced, can lead to the complication of multiple bowel fistulae. A VAC dressing creates a negative pressure environment that can facilitate wound healing by drawing together the edges of the wound and reducing fluid accumulation. However, in the context of a burst abdomen, this negative pressure can also inadvertently affect the integrity of the underlying bowel, particularly if there is a need for debridement or if there is pre-existing bowel compromise.

When a VAC dressing is applied over such a wound, there is a risk that excessive suction can lead to tissue necrosis or damage to the bowel, especially if the fascial layer is not intact or if the abdominal contents are not properly supported. This can result in the formation of fistulae, which are abnormal connections between the bowel and other structures, leading to complications such as leakage of bowel contents, further infection, and need for additional surgical interventions.

While the other options present potential risks associated with wound healing and infection, they are not as directly linked to the mechanism of injury that VAC dressings can impart on a compromised abdomen as the risk of multiple bowel fistulae. Thus, understanding the specific dynamics