Complications after 344 damage-control open celiotomies.
BACKGROUND
We reviewed our experience with the open abdomen and hypothesized that the known high wound complication rates were related to the timing and method of wound closure.


METHODS
All trauma admissions from 1995 through 2002 requiring an open abdomen and temporary abdominal coverage were included. The study group was then classified by three wound closure methods used in survivors: 1) primary (primary fascial closure); 2) temporizing (skin only, spit thickness skin graft and/or absorbable mesh), and 3) prosthetic (fascial repair using nonabsorbable prosthetic mesh).


RESULTS
In all, 344 patients required an open abdomen and temporary abdominal coverage either as part of a planned staged damage-control celiotomy (66%) or the development of the abdominal compartment syndrome (33%). Of these, 276 patients survived to wound closure. Sixty-nine of the 276 (25%) suffered wound complications (wound infection, abscess, and/or fistula). Thirty-four (12%) died after wound closure; seven of the deaths as a direct result of the wound complication. Complications increased significantly after 8 days (p < 0.0001) from the initial operative intervention to fascial closure. Primary fascial closure was achieved in 180 of 276 (65%) patients. Although there was no difference in the mean Injury Severity Score between the three groups, the primary group had significantly fewer mean transfusion requirements, shorter mean time to fascial closure, and a lower complication rate as compared with either the temporizing or prosthetic groups. The primary group thus incurred significantly less mean initial hospitalization charges.


CONCLUSIONS
Morbidity associated with wound complications from the open abdomen remains high (25%). Morbidity is associated with the timing and method of wound closure and transfusion volume, but independent on injury severity. Also, delayed primary fascial closure before 8 days is associated with the best outcomes with the least charges.
Miller
Richard S
RS
Section of Surgical Sciences, Division of Trauma and Surgical Critical Care, Vanderbilt University Medical Center, Nashville, Tennessee 37212, USA. richard.miller@vanderbilt.edu
Morris
John A
JA
Diaz
Jose J
JJ
Herring
Michael B
MB
May
Addison K
AK
D000007:Abdominal Injuries / Q000150:complications / Q000601:surgery*; D000038:Abscess / Q000209:etiology*; D000328:Adult; D003161:Compartment Syndromes / Q000209:etiology / Q000601:surgery; D000071938:Fasciotomy; D005260:Female; D006801:Humans; D007412:Intestinal Fistula / Q000209:etiology*; D007813:Laparotomy / Q000009:adverse effects*; D008297:Male; D012189:Retrospective Studies; D016038:Skin Transplantation; D013526:Surgical Mesh; D013530:Surgical Wound Infection / Q000209:etiology*; D013536:Suture Techniques / Q000009:adverse effects*; D013997:Time Factors