Faculty Collaboration Database

Linea alba fasciotomy: a novel alternative in trauma patients with secondary abdominal compartment syndrome. Am Surg 2010 Mar;76(3):312-6

Date

03/31/2010

Pubmed ID

20349663

Scopus ID

2-s2.0-77949534986 (requires institutional sign-in at Scopus site)   7 Citations

Abstract

Polytrauma patients needing aggressive resuscitation can develop intra-abdominal hypertension (IAH) with subsequent secondary abdominal compartment syndrome (SACS). After patients fail medical therapy, decompressive laparotomy is the surgical last resort. In patients with severe pancreatitis SACS, the use of linea alba fasciotomy (LAF) is an effective intervention to lower IAH without the morbidity of laparotomy. A pilot study of LAF was designed to evaluate its benefit in patients with SACS polytrauma. We conducted an observational study of blunt injury polytrauma patients undergoing LAF. Variables measured before and after LAF included intra-abdominal pressure (IAP, mmHg), abdominal perfusion pressure (APP, mmHg), right ventricular end diastolic volume index (RVEDVI, mL/m2), and ejection fraction. Of the five trauma patients with SACS, the mean age was 36 +/- 17, four (80%) male with an Injury Severity Score of 27 +/- 9. Pre- and post-LAF, IAP was 20.6 +/- 4.7 and 10.6 +/- 2.7 (P < 0.0001), APP 55.2 +/- 5.5 and 77.6 +/- 7.1 (P < 0.0001), RVEDVI 86.4 +/- 9.3 and 123.6 +/- 11.9 (P < 0.0001), and EF 27.6 +/- 4.2 and 40.8 +/- 5 (P < 0.0001), respectively. One patient needed full decompression for bile ascites from unrecognized liver injury. Linea alba fasciotomy, as a first-line intervention before committing to full abdominal decompression in patients with SACS trauma, improved physiological variables without mortality. Consideration for LAF as a bridge before full abdominal decompression needs further evaluation in patients with polytrauma SACS.

Author List

Duchesne JC, Howell MP, Eriksen C, Wahl GM, Rennie KV, Hastings PE, McSwain NE Jr, Malbrain ML

Author

Calvin Martin Eriksen MD Assistant Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Compartment Syndromes
Decompression, Surgical
Fasciotomy
Female
Humans
Male
Middle Aged
Multiple Trauma
Pancreatitis
Pilot Projects
Stroke Volume
Treatment Outcome
Ventricular Function, Right
Wounds, Nonpenetrating
Young Adult