Common terms for these plants are bur, burdock breech, stick tight, and cocklebur. I discourage the use of propriatory names and recommend using the generic name artificial bur, artificial bur closure or simply bur closure.
For surgical use as fascia prosthesis the term Bur Fascia Prosthesis describes most accurately its use.
A burr-like device to facilitate temporary abdominal closure in planned multiple laparotomies.1
Only tangential force, not vertical pull, surpassed manifold the force required to disrupt a native fascia.
The results of bacterial colonization, growth, and adherence to the polypropylene and polyamide material using special sonication technique for bacterial recovery showed no measurable risk to the patient. The testing was done before I regularly applied the Hypopack to prevent additional contamination. In this scenario exogenous contamination from outside was possible. Even under this condition we were not able to show any enhancement of bacterial colonization of the bur and wound. Cultures of the bur and the peritoneum showed the same bacterial pattern.
We also measured bacterial counts within the peritoneal fluid after 24, 48, and 72 hours and results showed that within 24 hours after irrigation of the peritoneum, bacterial counts were back to their original value. This finding supports the 24 interval between STAR entries in cases of intra-abdominal infection2,3.
I independently collected data from my patients and entered the data into a register. Patients or families were always consulted prior to the STAR procedure and gave informed consent. At this time fellow surgeons became aware of the efficacy of the device and started requesting samples which I couldn't initiallty provide.
Finally a group consisting of Dr. Copper - Dean of the Medical College, Dr. Condon - Chairman of our department, a legal consultant and I decided that I should use the device on a compassionate basis and abide by the guidelines I had provided in my study protocol for the IRB that was initially approved.
In 1988 I took the patient information and analysis of results to the FDA and obtained approval to use the device in patients for temporary abdominal closure.
1 Wittmann DH, Aprahamian C, Bergstein JM et al. A burr-like device to facilitate temporary abdominal closure in planned multiple laparotomies. Eur J Surg 1993;159(2):75-79
2 Edmiston CE, Jr., Goheen MP, Kornhall S, Jones FE, Condon RE. Fecal peritonitis: microbial adherence to serosal mesothelium and resistance to peritoneal lavage. World J Surg 1990;14(2):176-183
3 Wittmann DH. Operative and nonoperative therapy of intraabdominal infections. Infection 1998;26(5):335-341
1 Wittmann DH, Bergstein JM, Frantzides C. Calculated empiric antimicrobial therapy for mixed surgical infections. Infection 1991;19 Suppl 6:S345-S350
2 Wittmann DH, Syrrakos B, Wittmann MM. Advances in the diagnosis and treatment of intra-abdominal infection. In: Nyhus L, Nichols RL, editors. Problems in General Surgery: Surgical Sepsis, 1992 and beyond. 10 ed. Philadelphia: J.B. Lippincott Company; 1993:604-627
3 Wittmann DH, Aprahamian C, Bergstein JM et al. A burr-like device to facilitate temporary abdominal closure in planned multiple laparotomies. Eur J Surg 1993;159:75-79
4 Wittmann DH, Schein M, Condon RE. Management of secondary peritonitis. Ann Surg 1996;224(1):10-18
5 Wittmann DH. Newer methods of operative therapy for peritonitis. In: Nyhus LM, Baker RJ, Fischer JE, editors. Mastery of Surgery. 3 ed. Boston: Little, Brown and Company; 1996:146-152
6 Wittmann DH. Operative and non-operative therapy of intraabdominal infections. Infection 1998;26(5):335-341
7 Wittmann DH, Wittmann AM. Scope and limitations of antimicrobial therapy of sepsis in surgery. Langenbecks Arch Surg 1998;383(1):15-25
8 Aprahamian C, Schein M, Wittmann D. Cefotaxime and metronidazole in severe intra-abdominal infection. Diagn Microbiol Infect Dis 1995;22(1-2):183-188
9 Schein M, Wittmann DH, Holzheimer R, Condon RE. Hypothesis: compartmentalization of cytokines in intra-abdominal infection. Surgery 1996;119(6):694-700
Körte. Tharapie der Peritonitis. Grenzgebieten der Med u Chir 1897
Wittmann DH, Goris RJA, Rangabashyam N, Sayek I. Laparostomy, open abdomen, etappenlavage, planned relaparotomy and staged abdominal repair: too many names for a new operative method. In: Ruedi, editor. State of the Art of Surgery. Reinach, Switzerland: International Society of Surgery; 1994:23-27
Wittmann DH, Wallace JR, Schein M. Open abdomen, planned relaparotomy, or staged abdominal repair: is there a difference? World J Surg 268, S49. 1994