How I do itOne hundred percent fascial approximation with sequential abdominal closure of the open abdomen
Section snippets
Technique
At the initial exploration for either postinjury damage control, primary or secondary abdominal compartment syndrome, or abdominal catastrophes, temporary closure of the abdomen is accomplished by a subfascial 1010 Steri-Drape (3M Health Care, St. Paul, MN), blue towel or laparotomy pad coverage, Jackson-Pratt (JP) (Bard, Covington, GA) drain placement, and Ioban (3M Health Care) coverage. After this initial temporary closure and subsequent normalization of the patient’s physiology, we begin
Case Series
Patients undergoing this technique for open abdomen since its introduction in January 2005 at our level I trauma center were reviewed. Fourteen patients underwent sequential abdominal closure during the study period: 9 because of damage-control surgery (8 trauma and 1 general surgery) and 5 because of secondary abdominal compartment syndrome (3 trauma, 1 pancreatitis, and 1 ruptured abdominal aortic aneurysm). The majority were men (79%) with a mean age of 41.0 ± 5.7 years. Average time to
Comments
Management of the open abdomen has become an obligatory conundrum for general and trauma surgeons performing damage-control surgery. Although there is decreased mortality in these critically ill patients, the trade-off is morbidity of the resultant open abdomen. Although techniques have evolved to assist in the delayed closure of these patients’ abdomens, all would agree that primary fascial closure is the ideal. We propose a modification of the previously described VAC technique that achieves
References (9)
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Skin only or silo closure in the critically ill patient with an open abdomen
Am J Surg
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Use of a vacuum-assisted device to facilitate abdominal closure
Am Surg
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Late fascial closure in lieu of ventral herniathe next step in open abdomen management
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Temporary closure of open abdominal wounds by the modified sandwich-vacuum pack technique
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Cited by (143)
Bogotà bag for pediatric Open Abdomen
2020, Journal of Pediatric Surgery Case ReportsOpen Abdomen Therapy with Vacuum and Mesh Mediated Fascial Traction After Aortic Repair: an International Multicentre Study
2017, European Journal of Vascular and Endovascular SurgeryEmergent laparotomy and temporary abdominal closure for the cirrhotic patient
2017, Journal of Surgical ResearchDirect peritoneal resuscitation: A novel adjunct to damage control laparotomy
2019, Critical Care NurseCitation Excerpt :The drain is secured to the skin with a stitch, with the extracorporeal length secured temporarily with a plug, an atraumatic clamp, or a bulb suction device. Most commonly, temporary abdominal closure is achieved with a wound vacuum (vacuum-assisted closure [VAC]) dressing of some type, whether using a “homemade” vacuum pack (sterile perforated radiograph cassette drape; compressible dressing material such as towels, laparotomy pads, or gauze bandage roll; and drains with suction)28-32 or a proprietary open abdomen negative pressure therapy system, such as ABTHERA (KCI Medical).33-35 Resuscitation then continues in the ICU.