Overview
Complex abdominal wall defects resulting from trauma or severe intra abdominal sepsis complicated by abdominal compartment syndrome present a significant challenge to reconstructive surgeons. Delayed abdominal wall reconstruction remains a well established strategy in the management of such patients.

This case series describes the use of the TopClosure® Tension Relief System as a viable alternative for functional restoration of the abdominal wall.

Case Series Description
We report a case series on delayed abdominal wall reconstruction using the TopClosure® Tension Relief System. The series included three consecutive patients aged 18 years and above who were admitted to our surgical unit with intra abdominal sepsis between 2019 and 2021 at a private tertiary care centre.

Emergent laparotomies and peritoneal washouts were performed as part of sepsis control. This was followed by management in the critical care unit for physiological stabilization and optimization.

The TopClosure® system was then applied in combination with negative pressure wound therapy (NPWT) with instillation using normal saline and oxygen. This approach reduced bowel and anterior abdominal wall oedema while facilitating continuous irrigation to remove effluent and infectious material and prevent loss of abdominal wall domain.

Outcomes
Definitive closure was achieved in all patients within 5 to 10 days of applying the TopClosure® system, with a mean hospital stay of 32 days.

The only complication observed was a superficial surgical site infection in one patient, which was managed conservatively. All patients were followed up for six months after discharge.

Conclusion
Our experience suggests that the combined use of the TopClosure® system and NPWT with instillation is a feasible option for delayed abdominal wall reconstruction in resource limited health systems with favorable short term outcomes.

This approach reduces the need for grafts or microsurgical techniques and facilitates early functional recovery.