Covering the "open abdomen": a better technique.
"Damage control" in severe abdominal trauma, abdominal compartment syndrome, necrotizing fasciitis of the abdominal wall, and necrotizing pancreatitis often preclude closure of the fascia after laparotomy. Many techniques have been reported for temporary coverage of the exposed viscera, but most have had documented problems. We report the successful use, since 1989, of a temporary sutureless coverage. The viscera are covered with omentum when possible, then with a clear plastic sheet. Sump drains are placed over this layer. The entire abdomen is then covered with two layers of iodophor-impregnated adhesive plastic drape. The last 50 patients managed with this technique are reported. The most common indication (27 patients) was for treatment of severe abdominal trauma. There were no wound infections, fasciitis, or bowel obstruction. Eighteen patients died; no deaths were related to abdominal closure. Temporary abdominal covering with adhesive plastic sheeting is a rapid, safe, and readily available method for managing the open abdomen. This technique provides a physiologic milieu for the abdominal viscera, simplifies nursing care, and promotes safe closure of the abdomen at a later time.
Sherck
J
J
Department of Surgery, Stanford University Medical School and Santa Clara Valley Medical Center, San Jose, California 95128, USA.
Seiver
A
A
Shatney
C
C
Oakes
D
D
Cobb
L
L
D000005:Abdomen / Q000601:surgery*; D000007:Abdominal Injuries / Q000601:surgery; D000009:Abdominal Muscles / Q000601:surgery; D000269:Adhesives; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000891:Anti-Infective Agents, Local / Q000008:administration & dosage / Q000627:therapeutic use; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D003161:Compartment Syndromes / Q000601:surgery; D004322:Drainage / Q000295:instrumentation; D005208:Fasciitis / Q000517:prevention & control; D019115:Fasciitis, Necrotizing / Q000601:surgery; D000071938:Fasciotomy; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000517:prevention & control; D007466:Iodophors / Q000008:administration & dosage / Q000627:therapeutic use; D007813:Laparotomy / Q000295:instrumentation / Q000379:methods* / Q000451:nursing; D008297:Male; D008875:Middle Aged; D009779:Occlusive Dressings; D009852:Omentum / Q000601:surgery; D019283:Pancreatitis, Acute Necrotizing / Q000601:surgery; D010969:Plastics; D011183:Postoperative Complications / Q000517:prevention & control; D013530:Surgical Wound Infection / Q000517:prevention & control; D013537:Sutures
D000269:Adhesives; D000891:Anti-Infective Agents, Local; D007466:Iodophors; D010969:Plastics