Dynamic retention: a technique for closure of the complex abdomen in critically ill patients.
Management of the open abdomen in the setting of massive visceral swelling or extensive intra-abdominal abscess may pose an extremely difficult surgical scenario. We herein describe the technique and results of dynamic-retention sutures used in 13 patients with abdominal catastrophes after trauma, vascular reconstruction, tumor extirpation, and intra-abdominal infection. Three of these patients died during their acute care hospitalization. The remaining 10 patients were discharged to home with no resultant fistulas and 1 recurrent hernia (10%). Dynamic-retention sutures provide a useful technique for the closure of the complex surgical abdomen. We observed a low complication rate. In properly selected patients, this technique avoids the use of mesh or additional surgical procedures such as skin grafting or plastic surgical reconstruction of the abdominal wall.
Koniaris
L G
LG
Department of Surgery, University of Rochester School of Medicine and Dentistry, 601 Elmwood Ave, Rochester, NY 14562, USA.
Hendrickson
R J
RJ
Drugas
G
G
Abt
P
P
Schoeniger
L O
LO
D018806:APACHE; D000009:Abdominal Muscles / Q000601:surgery*; D000328:Adult; D000368:Aged; D002648:Child; D016638:Critical Illness; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013536:Suture Techniques; D013537:Sutures