Pediatric vacuum packing wound closure for damage-control laparotomy.
OBJECTIVE
Recent studies advocate the use of the open-abdomen technique for managing the abdominal compartment syndrome and uncontrolled intraperitoneal sepsis. The authors have used vacuum packing (Vac-Pac) in pediatric patients with excellent results and have developed a method for closing widely distracted fascial edges to avoid the need for skin grafting.


METHODS
Patients who had an intraabdominal catastrophe best managed by a temporary open-abdomen technique were included. After damage control laparotomy, the Vac-Pac temporary closure was used. In 2 patients a corsetlike lacing was used to bring the widely separated fascial edges together gradually.


RESULTS
Five patients with intraabdominal sepsis and one with the abdominal compartment syndrome were included. The length of time the Vac-Pac was used ranged from 3 to 21 days. In 2 patients, the corset closure allowed wound approximation within 5 to 7 days. One patient died of overwhelming sepsis, the remainder of the patients survived.


CONCLUSIONS
The Vac-Pac technique for abdominal closure is a simple and inexpensive means by which to manage the open abdomen in the pediatric patient effectively. Use of a corset-type closure for wounds with widely distracted edges should eliminate the need for skin grafting over an open abdomen.
Markley
Michele A
MA
Section of Pediatric Surgery, Department of Surgery, The University of Oklahoma College of Medicine, Oklahoma City, OK, USA.
Mantor
P Cameron
PC
Letton
Robert W
RW
Tuggle
David W
DW
D000005:Abdomen / Q000473:pathology / Q000601:surgery; D000007:Abdominal Injuries / Q000601:surgery; D002675:Child, Preschool; D003161:Compartment Syndromes / Q000601:surgery; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007813:Laparotomy / Q000379:methods*; D008297:Male; D010538:Peritonitis / Q000601:surgery; D018805:Sepsis / Q000601:surgery; D013396:Suction; D013536:Suture Techniques; D014618:Vacuum; D014947:Wounds and Injuries / Q000601:surgery*