Basement Membrane Biological Graft as a Visceral Protective Layer During Negative Pressure-Assisted Temporary Abdominal Closure: An Exploratory Case Series

Background /Aim: Entero-atmospheric fistula (EAF) is a devastating complication of open abdomen (OA) therapy. Visceral protective layers (VPLs) reduce direct contact between exposed bowel and negative pressure materials. We describe the clinical use of a basement membrane biological graft as the VPL during negative pressure wound therapy–assisted temporary abdominal closure (NPWT–TAC). Materials and Methods: Retrospective single-center case series of consecutive adults receiving NPWT–TAC in whom a basement membrane biological graft was placed directly over exposed viscera. The primary outcome was new EAF during OA therapy. Secondary outcomes included delayed primary fascial closure, duration of NPWT–TAC, complications (Clavien–Dindo), length of stay, and incisional hernia on follow-up. Results: Seven patients (3 men, 4 women; mean age 58.4±9.8 years) underwent NPWT–TAC with the biologic graft VPL. Mean NPWT–TAC duration was 18.1 days (range 7–36) with a mean of 3.9 dressing changes. No patient developed EAF during therapy. Delayed primary fascial closure was achieved in four patients; three underwent skin grafting-based definitive coverage (one with subsequent abdominal wall reconstruction). Complications included pulmonary infection (n=3), wound bleeding (n=2), urinary tract infection (n=1), gastric retention (n=1), and fungal infection (n=1). Follow-up ranged from 2 to 12 months (median 5); all wounds healed and one patient developed an incisional hernia. Conclusions: In this exploratory case series, a basement membrane biological graft was feasible as a VPL during NPWT–TAC and no EAF occurred during therapy. Larger comparative studies are needed to determine whether biologic interfaces offer advantages over established inert VPLs within modern OA protocols.