title: Early definitive abdominal closure using serial closure technique on injured soldiers returning from Afghanistan and Iraq.
abstract: BACKGROUND
  Twenty-nine of 1,284 battle-injured soldiers arriving at Walter Reed Army Medical Center from Operations Enduring Freedom and Iraqi Freedom have abdominal wounds requiring delayed definitive closure with Gore-Tex (WL Gore & Assoc) mesh.
  
  
  METHODS
  Serial abdominal closure (SAC) leading to early definitive abdominal closure (EDAC) was achieved using Gore-Tex mesh. Inpatient records of Operations Enduring Freedom and Iraqi Freedom soldiers with open or reopened abdomens were reviewed from March 2003 to August 2005.
  
  
  RESULTS
  Twenty-nine soldiers, average age 27 years (range 20 to 42 years) injured by secondary blast effects (n = 19); penetrating (n = 8); motor vehicle crashes (n = 1); and crushing injury (n = 1) were included in the study. Patients arrived at Walter Reed Army Medical Center 8 days (range 3 to 56 days) after injury with Gore-Tex mesh placed 6 days (range 0 to 26 days) from arrival and 14 days (range 4 to 79 days) from injury. SAC was achieved with towel clamp tightening or excision of midline mesh and drawing fascia closer to the midline for an average of 46 days (range 15 to 160 days) before EDAC. One patient is undergoing SAC and another was transferred to another facility. EDAC was achieved in 24 of the remaining of 27 patients (89%). Four patients required early removal of the Gore-Tex mesh, resulting in three patients with planned ventral hernia. One patient underwent EDAC with primary closure and fascial release. EDAC was completed with polypropylene mesh in 17 patients and 6 patients had original Gore-Tex in place. Patients were discharged from the hospital an average of 18 days after closure (range 1 to 89 days) with total hospital days of 62 (range 17 to 197 days). Average followup of patients from placement of Gore-Tex mesh is 264 days (range 31 to 855 days).
  
  
  CONCLUSIONS
  SAC with Gore-Tex mesh led to EDAC in 89% of patients and proved to be a safe and effective alternative to planned ventral hernia. SAC allowed protection of abdominal contents, effective fluid management, reclamation of abdominal domain, and early rehabilitation with minimal complications and only one hernia reoccurrence.
authors.affiliation: Department of General Surgery, Walter Reed Army Medical Center, Washington, DC, USA. amy.vertrees@na.amedd.army.mil
authors.forename: Amy
authors.initials: A
authors.lastname: Vertrees
authors.forename: Dwight
authors.initials: D
authors.lastname: Kellicut
authors.forename: Shane
authors.initials: S
authors.lastname: Ottman
authors.forename: George
authors.initials: G
authors.lastname: Peoples
authors.forename: Craig
authors.initials: C
authors.lastname: Shriver
mesh_terms: D000007:Abdominal Injuries / Q000601:surgery*; D000328:Adult; D000346:Afghanistan; D005260:Female; D006801:Humans; D007493:Iraq; D008297:Male; D008889:Military Personnel; D012189:Retrospective Studies; D013526:Surgical Mesh; D013536:Suture Techniques; D013997:Time Factors; D016896:Treatment Outcome