TH5.8 Use of Botulinum Toxin A infiltration in conjunction with negative pressure wound dressing and mesh-mediated traction in the management of the ‘open abdomen’

Abstract Aims Botulinum Toxin A (BTA) is widely used in complex abdominal wall reconstruction (CAWR). It temporarily paralyses the oblique muscles allowing medialisation of rectus sheath and decreases tension on closure. This analysis presents use BTA management ‘open abdomen’ (OA). Methods Retrospective series patients with OA where was conjunction AbtheraTM negative pressure wound therapy (NPWT) polypropylene mesh-mediated traction (MMT) to attempt fascial performed by Anaesthetists experience CAWR using Dysport® 600 IU. Results We include 5 since 2020. Median age at index operation 55 years (range 39–81); four were male. Index operations intra-abdominal catastrophe fascia closure impossible (n=2), dehiscence after Vertical Rectus Abdominis Myocutaneous (VRAM) flap for pelvic malignancy (n=2) colectomy obstructing colorectal cancer complicated necrotising fasciitis (n=1). There no immediate complications from infiltration. All achieved primary a median five re-looks 3–7). full-thickness dehiscences final One patient died within 1 month unrelated cause. had clinically palpable incisional hernia six months further two 12 months, respectively, surveillance CT. Conclusion setting NPWT MMT appears safe effective achieving closure, can potentially reduce risk hernia. Further studies are welcomed.