[Packing: current concepts of "life-saving" surgery].
Abdominal packing is a lifesaving technique for temporary control of severe injury and it is used in Damage Control Surgery schedule. Technically bleeding from abdominal cavity can generally be achieved by applying pressure with several large abdominal packs. It's possible too applying packs in organ-specific techniques (early abdominal packing). A wide review of the literature has allowed to emphasize the most common problem of this technique, the adequacy of the particular indications, their evolution, timing, the results in general and particular which multiple critical situations and not always predictable when an intensive diagnostic and methodological approach is necessary in. The principal indications are when complex anatomic lesions are diagnosed with not ruleable hemorrhages, in presence of metabolic failure--like hypothermia < 35 degrees C, acidosis > 7.2, coagulopathy PTT > 16 seconds: these three derangements become established quickly in the exsanguinating trauma patient and, once established, form a vicious circle which may be impossible to overcome. The results are encouraging and we can evaluate a median survival of the 60%, certainly superior to the obtainable survival with immediate surgical repair. Immediate failures are substantially due to bleeding, especially in "underpacking" case, and remote: these last can be premises, fundamentally septic and bound at the time of stay (above the 72 hours) and associated by the coexistence of lesions; in these situations is possible a MOF syndrome due to excessive intraabdominal pressure (overpacking) or to an abdominal compartment syndrome.
Stagnitti
F
F
Istituto di Clinica Chirurgia d'Urgenza e Pronto Soccorso, Università degli Studi La Sapienza, Roma.
Mongardini
M
M
Schillaci
F
F
Ribaldi
S
S
Priore
F
F
Corona
F
F
Tiberi
R
R
D004635:Emergency Medicine; D006488:Hemostasis, Surgical / Q000379:methods*; D006801:Humans