Y. Wang1, A. Stanek1, J. Grushka1, P. Fata1, A. Beckett1, K. Khwaja1, T. Razek1, D. Deckelbaum1 1McGill University,Trauma Surgery,Montreal, QC, Canada
Introduction: The incidence of heterotopic ossification (HO) following damage control laparotomy is unclear. Abdominal wall reconstruction may prove more challenging in patients with HO. This study reviews the incidence of HO in patients who had an open abdomen post damage control laparotomy.
Methods: A retrospective review of all patients who had an open abdomen post damage control laparotomy between 2009 – 2015 at a level 1 trauma centre was conducted. Patient demographics, mechanism of injury, duration of open abdomen and number of surgeries prior to abdominal closure were reviewed. Heterotopic ossification was detected on computed tomography images and characterized based on location, dimensions and distance from the xiphoid.
Results: Of the 117 patients reviewed, 49 patients were excluded because of death (n= 27), lack of imaging studies (n = 19) or missing chart information (n = 3). Of the 68 patients included in the study, 36 (53%, 29 male, 7 female) developed HO. There were no significant differences in age, sex or mechanism of trauma between the HO group and the non-HO group. The HO group had a significantly longer time to definitive closure (6.5 vs. 2.0 days, p = 0.013) and a greater number of abdominal surgeries prior to closure (2 vs. 1, p = 0.002). The median time to detection of HO was 41 days. The median size of HO was 4.8 cm (craniocaudal) by 2.2 cm (axial), with a distance of 1.5 cm from the xiphoid.
Conclusion: Trauma patients treated with open abdomens post damage control laparotomy have a high incidence of heterotopic ossification. Development of HO is associated with a longer duration of open abdomen and a greater number of surgeries prior to definitive closure. The impact of HO on functional status and abdominal reconstruction should be better quantified. Prevention strategies including the use of non-steroidal anti-inflammatories should be evaluated.