Evolution of Fascial Closure Optimization in Damage Control Laparotomy

2016 ◽  
Vol 82 (12) ◽  
pp. 1178-1182
Author(s):  
Margaret H. Lauerman ◽  
Joseph J. Dubose ◽  
Deborah M. Stein ◽  
Samuel M. Galvagno ◽  
Matthew J. Bradley ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Odds Ratio ◽  
Damage Control ◽  
Enterocutaneous Fistula ◽  
Fascial Closure ◽  
Damage Control Laparotomy ◽  
Closure Rate ◽  
Urban Level ◽  
Level I ◽  
Primary Fascial Closure

Management of patients undergoing damage control laparotomy (DCL) involves many surgical, medical, and logistical factors. Ideal patient management optimizing fascial closure with regard to timing and closure techniques remains unclear. A retrospective review of patients undergoing DCL from 2000 to 2012 at an urban Level I trauma center was undertaken. Mortality of DCL decreased over the study period from 62.5 to 34.6 per cent, whereas enterocutaneous fistula rate decreased from 12.5 to 3.8 per cent. Delayed primary fascial closure rate improved from 22.2 to 88.2 per cent. Time to closure ( P < 0.001), time to first attempted closure ( P < 0.001), and number of explorations ( P < 0.001) were associated with ability to achieve delayed primary fascial closure. In subgroup analysis, achievement of delayed primary fascial closure was decreased with time to closure after one week (91.7% vs 52.0%, P = 0.002) and time to first attempted closure after two days (86.5% vs 70.0%, P = 0.042). In multivariate analysis, time to closure (odds ratio: 0.13, 95% confidence interval: 0.04–0.39; P < 0.001) and time to first attempted closure (odds ratio: 0.61, 95% confidence interval: 0.37–0.99; P = 0.046) were the only factors associated with achieving delayed primary fascial closure. Timing of attempted closure plays a significant role in attaining delayed primary fascial closure, highlighting the importance of early re-exploration.

Postoperative Neuromuscular Blocker Use Is Associated With Higher Primary Fascial Closure Rates After Damage Control Laparotomy

2010 ◽  
Vol 69 (3) ◽  
pp. 557-561 ◽  
Author(s):  
Chadi T. Abouassaly ◽  
William D. Dutton ◽  
Victor Zaydfudim ◽  
Lesly A. Dossett ◽  
Timothy C. Nunez ◽  
...  
Keyword(s):  
Damage Control ◽  
Neuromuscular Blocker ◽  
Fascial Closure ◽  
Damage Control Laparotomy ◽  
Primary Fascial Closure

Primary fascial closure after damage control laparotomy: Sepsis vs haemorrhage

Injury ◽  
2014 ◽  
Vol 45 (1) ◽  
pp. 151-155 ◽  
Author(s):  
Naeem Goussous ◽  
Donald H. Jenkins ◽  
Martin D. Zielinski
Keyword(s):  
Damage Control ◽  
Fascial Closure ◽  
Damage Control Laparotomy ◽  
Primary Fascial Closure

Time to first take-back operation predicts successful primary fascial closure in patients undergoing damage control laparotomy

Surgery ◽  
2014 ◽  
Vol 156 (2) ◽  
pp. 431-438 ◽  
Author(s):  
Matthew J. Pommerening ◽  
Joseph J. DuBose ◽  
Martin D. Zielinski ◽  
Herb A. Phelan ◽  
Thomas M. Scalea ◽  
...  
Keyword(s):  
Damage Control ◽  
Fascial Closure ◽  
Damage Control Laparotomy ◽  
Take Back ◽  
Primary Fascial Closure

Wittmann Patch

2020 ◽  
Vol 86 (8) ◽  
pp. 981-984
Author(s):  
Hannah M. Nemec ◽  
D. Benjamin Christie ◽  
Anne Montgomery ◽  
Danny M. Vaughn
Keyword(s):  
Injury Severity ◽  
Damage Control ◽  
Active Form ◽  
Fascial Closure ◽  
Closure Device ◽  
Closure Rate ◽  
Life Saving ◽  
Level 1 ◽  
Level 1 Trauma Center ◽  
Primary Fascial Closure

Introduction Damage control laparotomy (DCL) is a life-saving surgical technique, but the resultant open abdomen (OA) carries serious morbidity/mortality. Many methods are utilized to manage OAs, but discrepancy exists in distinguishing closure from coverage techniques. We observed a difference in our DCL patient outcomes managed with the Wittmann Patch (WP) closure device versus the more popular ABThera (AB) coverage device. We hypothesized that the WP contributed to an improved fascial closure rate of the OAs after DCL. Methods A retrospective review of OAs managed with the AB or WP at our Level 1 trauma center was performed using billing codes to capture DCL patients from 2011 to 2019. Patients were divided into AB alone or WP groups. Major endpoints included primary fascial closure (PFC) and delayed fascial closure (DFC, fascial closure after greater than 7 days). Results 189 patients were identified as AB and 38 as WP. Rates of death before closure, age, gender, and Injury Severity Score were similar in both groups. PFC = 81%-90% for AB versus WP, respectively. Excluding patients with preexisting hernias PFC = 87%-100% for AB versus WP ( P < .05) and DFC = 44%-100% for AB versus WP ( P ≤ 0.001). WP had a statistically higher rate of PFC and DFC. There was a decreased incidence of complications in the WP versus AB group. Conclusions While not well reported in the peer-reviewed literature, the application of the WP for management of the OA is an active form of pursuing PFC when compared with the AB, a coverage device. Our interinstitutional results have demonstrated superior PFC and DFC rates and fewer complications, in patients managed with the WP compared with the AB.

scholarly journals Predictors of primary fascial closure failure in trauma damage control laparotomy

2022 ◽  
Author(s):  
Beatriz Bibiana Aguirre Patiño ◽  
Fernando Rodríguez Holguín ◽  
Julián Chica ◽  
Carlos Gallego ◽  
Alberto Federico García Marín
Keyword(s):  
Damage Control ◽  
Fascial Closure ◽  
Damage Control Laparotomy ◽  
Primary Fascial Closure

An Innovative Way to Separate Gastrointestinal and Abdominal Wall Reconstruction after Complex Abdominal Trauma

2017 ◽  
Vol 83 (9) ◽  
pp. 1001-1006 ◽  
Author(s):  
David H. Livingston ◽  
David V. Feliciano
Keyword(s):  
Abdominal Wall ◽  
Damage Control ◽  
Abdominal Wall Reconstruction ◽  
Skin Grafting ◽  
Small Bowel Resection ◽  
Fascial Closure ◽  
Thickness Skin ◽  
Split Thickness Skin Grafting ◽  
Staged Approach ◽  
Level I

Despite advances in trauma care, a subset of patients surviving damage control cannot achieve fascial closure and require split-thickness skin grafting (STSG) of their open abdomen. Controversy exists as to whether reconstruction of the gastrointestine (GI) should be staged or performed at the time of abdominal wall reconstruction (AWR). Many surgeons do not believe that operations through the STSG can be completed safely or without loss of graft. This series reviews the outcomes of operations for GI reconstruction performed through the elevated healed STSG. Concurrent series on all patients undergoing abdominal operation through the STSG. The technique involves elevating the STSG, lysing adhesions only as needed, avoid detaching underlying omentum or viscera to avoid devascularization, and then reattaching the elevated STSG to the abdominal wall with simple sutures. From 1995 to 2017, 27 patients underwent 40 distinct procedures during 36 separate abdominal reoperations (89% GI) through the elevated STSG approach at three Level I trauma centers at a mean interval of 11 months from application of the STSG. One STSG was lost (patient closed with skin flaps), one patient had 30 per cent loss of the STSG (regrafted), and one patient had 10 per cent loss of the STSG (allowed to granulate). One patient required a small bowel resection for intraoperative enterotomy during a difficult operative dissection. There were no GI complications, intraabdominal infections, or deaths, and all patients were deemed fit to undergo AWR after three months. Major intraabdominal reoperations can be readily and safely accomplished through the elevated STSG approach with a <4 per cent need for regrafting. This staged approach significantly simplifies and increases the safety of a second stage AWR.

A Prospective Look at the Current State of Open Abdomens

2008 ◽  
Vol 74 (10) ◽  
pp. 891-897 ◽  
Author(s):  
Pedro G.R. Teixeira ◽  
Ali Salim ◽  
Kenji Inaba ◽  
Carlos Brown ◽  
Timothy Browder ◽  
...  
Keyword(s):  
Skin Grafting ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Fascial Closure ◽  
Stepwise Logistic Regression ◽  
Trauma Patients ◽  
Closure Rate ◽  
Abdominal Closure ◽  
Academic Level ◽  
Level I

The present study examines the current management, closure rate, and complications of open abdomens in trauma patients admitted to an Academic Level I trauma center between May 2004 and April 2007. Variables examined include mechanism, injuries, use of antibiotics and paralytics, type of abdominal closure, days to closure, complications, ICU and hospital length of stay, and mortality. Stepwise logistic regression was performed to identify independent predictors of failed abdominal closure. Of 900 laparotomies, 93 (10%) were left open. Eighty-five (91%) patients survived for closure opportunity. Definitive fascial closure was achieved in 72 (85%) at 3.9 ± 3.7 days (range 1–21 days). Of the remaining 13 patients, seven were closed with biologic material, five by skin grafting, and one had skin-only closure. Entero-atmospheric fistulas occurred in 14 (15%) patients. Two independent risk factors associated with failed abdominal closure were the presence of deep surgical site infection [odds ratio (OR) 17.4; 95% confidence interval (CI) 2.6–115.8, P = 0.003] and intra-abdominal abscess (OR 7.4; 95% CI 1.1–51.0, P = 0.04). In conclusion, open abdomens are commonly necessary after trauma laparotomies. Definitive fascial closure can be achieved in 85 per cent of cases. In conjunction with biologics, closure can be achieved in 93 per cent of cases. Failure to primarily close the abdomen is associated with a significantly higher risk for entero-atmospheric fistula occurrence.

scholarly journals Difference Between Delayed Anastomosis and Early Anastomosis in Damage Control Laparotomy Affecting the Infusion Volume and NPWT Output volume: Is Infusion Restriction Necessary in Delayed Anastomosis? A Single-Center Retrospective Analysis

2021 ◽  
Author(s):  
Yohta Tanahashi ◽  
Hisaho Sato ◽  
Akiko Kawakami ◽  
Shusaku Sasaki ◽  
Yu nishinari ◽  
...  
Keyword(s):  
Retrospective Analysis ◽  
Emergency Surgery ◽  
Damage Control ◽  
Fascial Closure ◽  
Temporary Abdominal Closure ◽  
Artificial Anus ◽  
Single Center ◽  
Damage Control Laparotomy ◽  
Second Look ◽  
Output Volume

Abstract Background: Delayed anastomosis is a treatment strategy used in damage control laparotomy (DCL). During temporary abdominal closure (TAC) with DCL, infusion volume, and negative-pressure wound therapy (NPWT) output volume are associated with the success and prognosis of primary fascial closure (PFC). The same may also hold true for anastomosis. The aim of this research is to evaluate whether the difference between early anastomosis and delayed anastomosis in DCL is related to infusion volume and NPWT output volume.Methods: This single-center retrospective analysis targeted patients managed with TAC during emergency surgery for trauma or intra-abdominal sepsis between January 2011 and December 2019. It included patients who underwent repair/anastomosis/artificial anus construction in the first surgery and patients who underwent intestinal resection in the first surgery followed by delayed anastomosis with no intestinal continuity. The main outcomes were infusion volume, NPWT output volume and complications.Results: One hundred nine patients who underwent emergency surgery were evaluated. Seventy-three patients were managed with TAC using NPWT. In 16 patients with early anastomosis and 21 patients with delayed anastomosis, there was no difference in the infusion volume (p=0.2318) or NPWT output volume (p=0.7128) 48 hours after surgery. Additionally, there was no difference in the occurrence of surgical site infection (p=0.315) and suture failure (p=0.8428). During the second-look surgery after 48 hours, the anastomosis was further postponed for 48% of the patients who underwent delayed anastomosis. There was no difference in the infusion volume (p=0.0783) up to the second-look surgery between the patients whose delayed anastomosis was postponed and those who underwent delayed anastomosis, but there was a tendency toward a large NPWT output volume (p=0.024) in the postponed delayed anastomosis group. Anastomosis and PFC were achieved for all patients whose delayed anastomosis was postponed.Conclusions: The presence or absence of anastomosis during TAC management does not affect NPWT output volume. Delayed anastomosis may be managed with the same infusion volume as that used for early anastomosis. There is also the option of postponing anastomosis if the planned delayed anastomosis is complicated.Trial RegistrationThe retrospective protocol of this study was approved by our institutional review board (MH2018-611).

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