Commentary on Predictors of Failed Primary Abdominal Closure in the Trauma Patient with an Open Abdomen
ARMY INST OF SURGICAL RESEARCH FORT SAM HOUSTON TX
Pagination or Media Count:
Damage-control laparotomy is the mainstay of therapy for the management of abdominal trauma in physiologically ill patients. The goals of damage-control laparotomy include hemostasis and control of contamination, with some form of temporary abdominal closure TAC needed upon completion of the abbreviated laparotomy. Ideally, TAC should be atraumatic, be rapidly and easily applied, minimize the risk of intraabdominal hypertension, control peritoneal effluent, allow for quick reentry into the peritoneum, and maximize future attempts to achieve primary fascial closure. The result of the prolonged open abdomen leads to the loss of abdominal wall domain and the need for skin autografting over viscera with planned ventral hernia. As the open abdomen after injury became more common, many TAC methods were developed to include towel-clip skin closure, suture skin closure, Bogota bag, synthetic mesh, mesh zipper, Wittmann patch, three-layer negative-pressure dressing, fascial sutures, and commercial negative-pressure dressings. The methods that are most commonly used can be classified into two main groups negative-pressure dressings of varying complexity and cost and techniques that apply traction to the fascia andor skin to limit retraction and theoretically prevent further domain loss. To date, no method has been borne out to be superior to the other. A review suggested that although the generic three-layer vacuum pack technique nonadhesive bowel drape, towel, closed suction drains for TAC is the standard, other methods should be measured against it and the choice of TAC should be a matter of surgeon preference.
- Anatomy and Physiology
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