The management of the open abdomen in trauma and emergency general surgery: part 1-damage control.
BACKGROUND
The open abdomen technique, after both military and civilian trauma, emergency general or vascular surgery, has been used in some form for the past 30 years. There have been several hundred citations on the indications and the management of the open abdomen. Eastern Association for the Surgery of Trauma practice management committee convened a study group to organize the world's literature for the management of the open abdomen. This effort was divided into two parts: damage control and the management of the open abdomen. Only damage control is presented in this study. Part 1 is divided into indications for the open abdomen, temporary abdominal closure, staged abdominal repair, and nutrition support of the open abdomen.


METHODS
A literature review was performed for more than 30 years. Prospective and retrospective studies were included. The reviews and case reports were excluded. Of 1,200 articles, 95 were selected. Seventeen surgeons reviewed the articles with four defined criteria. The Eastern Association for the Surgery of Trauma primer was used to grade the evidence.


RESULTS
There was only one level I recommendation. A patient with documented abdominal compartment syndrome should undergo decompressive laparotomy.


CONCLUSIONS
The open abdomen technique remains a heroic maneuver in the care of the critically ill trauma or surgical patient. For the best outcomes, a protocol for the indications, temporary abdominal closure, staged abdominal reconstruction, and nutrition support should be in place.
Division of Trauma and Surgical Critical Care, Department of Surgery, Vanderbilt University Medical Center, 1211 21st Avenue South, 404 Medical Arts Building, Nashville, TN 37212, USA. jose.diaz@vanderbilt.edu
Jose J
JJ
Diaz
Daniel C
DC
Cullinane
William D
WD
Dutton
Rebecca
R
Jerome
Richard
R
Bagdonas
Jaroslaw W
JW
Bilaniuk
Jarolslaw O
JO
Bilaniuk
Bryan R
BR
Collier
John J
JJ
Como
John
J
Cumming
Maggie
M
Griffen
Oliver L
OL
Gunter
John
J
Kirby
Larry
L
Lottenburg
Nathan
N
Mowery
William P
WP
Riordan
Niels
N
Martin
Jon
J
Platz
Nicole
N
Stassen
Eleanor S
ES
Winston
D000007:Abdominal Injuries / Q000601:surgery*; D003161:Compartment Syndromes / Q000601:surgery; D019299:Decompression, Surgical / Q000379:methods; D004638:Emergency Treatment; D013502:General Surgery; D006801:Humans; D007813:Laparotomy / Q000379:methods; D017410:Practice Guidelines as Topic; D014950:Wounds, Penetrating / Q000601:surgery*