Vacuum Pack Technique of Temporary Abdominal Closure: A 7-Year Experience with 112 Patients
| Autor: | Charles M. Richart, Donald E. Barker, David L. Ciraulo, Richard N. Burns, Henry Kaufman, Lisa Smith |
|---|---|
| Rok vydání: | 2000 |
| Předmět: |
Adult
Male Reoperation Laparoscopic surgery Damage control medicine.medical_specialty Time Factors Adolescent Vacuum medicine.medical_treatment Abdominal Injuries Critical Care and Intensive Care Medicine medicine Humans Closure (psychology) Child Aged Aged 80 and over business.industry Mortality rate Medical record Suture Techniques Middle Aged Surgery medicine.anatomical_structure Child Preschool Abdomen Skin grafting Female business Complication |
| Zdroj: | The Journal of Trauma: Injury, Infection, and Critical Care. 48:201-207 |
| ISSN: | 0022-5282 |
| DOI: | 10.1097/00005373-200002000-00001 |
| Popis: | Background: Temporary abdominal wound closure after celiotomy for trauma is often desirable. The ideal method of temporary closure should allow rapid closure, easy maintenance, and allow reexploration and wound repair with minimal tissue damage. Over the past 7 years, we have successfully used a vacuum closure system (the vacuum pack) for temporary management of the open abdomen. Methods: Medical records of trauma patients undergoing exploratory celiotomy from April of 1992 to February of 1999 were reviewed. Demographic data as well as indications for open-abdominal management and complications of open-abdominal management were collected. Results: Two hundred sixteen vacuum packs were performed in 112 trauma patients. Of the 216 vacuum packs placed, 2.8% were placed for increased intra-abdominal pressure, 5.3% for inability to achieve tension-free fascial closure, 20% for damage control, 55% for reexploration, and 16.7% for a combination of factors. Sixty-two patients (55.4%) went on to primary closure and 25 patients (22.3%) underwent polyglactin mesh repair of the defect followed by wound granulation and eventual skin grafting. Twenty-two patients (19.6%) died before abdominal closure was attempted. Five patients (4.5%) developed enterocutaneous fistulae. Five patients (4.5%) developed intra-abdominal abscesses. There were no eviscerations. Three patients (2.7%) required further explorations after abdominal closure. Overall mortality rate was 25.9%, none related to the vacuum pack. Conclusions: The vacuum pack is the temporary abdominal wound closure of choice in patients undergoing open abdominal management at our institution. Primary closure is achieved in the majority of patients with a low rate of complication. The technique is simple and easily mastered. Technical complications are rare and easily repaired. |
| Databáze: | OpenAIRE |
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