A. N. Hildreth1, P. R. Miller1, M. C. Chang1, F. Marayati2, J. W. Meredith1 1Wake Forest University School Of Medicine,Department Of Surgery,Winston-Salem, NC, USA 2Princeton University,Princeton, NJ, USA
Introduction: Damage control laparotomy following trauma remains common, and management of the open abdomen presents substantial challenges. In 2004, our group reported a technique of vacuum-assisted fascial closure (VAFC) after open abdomen, with a closure rate of 88% and a mean time to closure of 9.5 days. After 15 years of using this technique, we examine our recent experience for durability of the results.
Methods: The trauma registry at our level 1 trauma center was queried over a 21-month period to identify patients who underwent laparotomy for trauma. Patients requiring management with an open abdomen after initial laparotomy were selected, and chart review was performed to determine fascial closure rate, time to closure, and related complications.
Results: From January 2013 to March 2016, 336 patients underwent laparotomy for trauma; 96 (28.5%) of these required management of the open abdomen. Mean injury severity score for this group was 29; 55 (57.2%) survived until abdominal closure or Vicryl mesh placement. VAFC was used in all patients to attempt closure. Closure rate was 89% (49), with mean time to closure of 4.7 days (range 1-19 days). Mean number of laparotomies prior to closure was 1.3. Complications in closure group included four ventral hernias, two enterocutaneous fistulae, and three episodes of fascial dehiscence.
Conclusion: VAFC continues to result in high rates of successful abdominal closure. Since the inception of this technique at our facility, the majority of patients with an open abdomen have successful closure, with consistent rates over a period of 15 years. Although closure after several weeks remains possible, time to closure is considerably decreased with increased experience.