title: Early one-stage closure in patients with abdominal compartment syndrome: fascial replacement with human acellular dermis and bipedicle flaps.
abstract: Decompressive celiotomy for the treatment of abdominal compartment syndrome (ACS) often results in wounds that are difficult to close. These complicated wounds are frequently managed with a 3-staged surgical approach employing a planned ventral hernia. The authors describe an alternative closure with a single operation using a commercially available human acellular dermis (HACD) as a fascial substitute. Soft tissue coverage is obtained at the same operation by means of bilateral bipedicle flaps. The cohort consisted of 9 patients, ages 19 to 77 years old. On average patients were closed on the ninth postoperative day (range, 3 to 30 days) and were discharged from the trauma center on average 8 days (range, 5 to 29 days) after the abdominal closure. Complications developed in 3 (33%) patients. These complications included a flap hematoma, wound infection, and recurrent hernia. There were no postoperative fistulas. This procedure allows for early, single-staged closure of the abdomen after abdominal compartment syndrome. Once closed, patients were able to be discharged from the hospital early and without need for specialized wound care. Further investigation on the usefulness of this technique is required.
authors.affiliation: Division of Trauma, Section of Surgical Sciences, Vanderbilt University, School of Medicine, Nashville, Tennessee 37232-3755, USA.
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Guy
authors.forename: Richard
authors.initials: R
authors.lastname: Miller
authors.forename: John A
authors.initials: JA
authors.lastname: Morris
authors.forename: Jose
authors.initials: J
authors.lastname: Diaz
authors.forename: Addison
authors.initials: A
authors.lastname: May
mesh_terms: D000009:Abdominal Muscles / Q000601:surgery*; D000328:Adult; D000368:Aged; D003161:Compartment Syndromes / Q000601:surgery*; D019299:Decompression, Surgical; D005260:Female; D006801:Humans; D007813:Laparotomy; D008297:Male; D019736:Prostheses and Implants; D019651:Plastic Surgery Procedures / Q000379:methods*; D017768:Skin, Artificial; D013524:Surgical Flaps