Alternative approaches to abdominal wound closure in severely injured patients with massive visceral edema. J Trauma 1992 Jan;32(1):16-20
Date
01/01/1992Pubmed ID
1732567DOI
10.1097/00005373-199201000-00004Scopus ID
2-s2.0-0026521738 (requires institutional sign-in at Scopus site) 103 CitationsAbstract
Excessive tension in an abdominal incision line may lead to fascial necrosis and wound sepsis. We utilized two alternative approaches to wound closure in 13 patients with severe abdominal trauma (2 blunt, 11 penetrating) whose midline incision could not be closed primarily without excessive tension at the initial operation because of massive visceral edema. In five patients synthetic mesh was used to bridge the fascial defect. Four patients survived the early postoperative period but had large open midline wounds that required one or more delayed procedures to close the wound or cover the visceral mass with skin graft. Two patients currently have large abdominal wall hernias. In the other eight patients the skin was reapproximated over the visceral mass utilizing towel clips at the initial operation. Six patients survived to be reexplored within 48-96 hours. Acute hemorrhage had stopped, the edema of the bowel and retroperitoneum had largely resolved, and the fascia could be closed primarily without excessive tension. All wounds went on to heal satisfactorily. When massive edema makes fascial closure at the initial operation difficult or impossible, closure of the skin over the visceral mass promotes resolution of the edema and often allows satisfactory primary closure within 48-96 hours. Synthetic mesh should be reserved for cases of abdominal wall tissue loss or dehiscence associated with wound sepsis.
Author List
Smith PC, Tweddell JS, Bessey PQMESH terms used to index this publication - Major topics in bold
Abdominal InjuriesAdult
Edema
Humans
Injury Severity Score
Male
Middle Aged
Surgical Mesh
Surgical Wound Dehiscence
Suture Techniques
Wounds, Nonpenetrating
Wounds, Penetrating
