Primary skin closure after damage control laparotomy.
BACKGROUND
Damage control laparotomy (DCL) is used widely in the management of patients with traumatic injuries but carries significant morbidity. Surgical-site infection (SSI) also carries potential morbidity, increased costs and prolonged hospital stay. The aim of this study was to determine whether primary skin closure after DCL increases the risk of SSI.


METHODS
This was a retrospective institutional review of injured patients undergoing DCL between 2004 and 2012. Outcomes of patients who had primary skin closure at the time of fascial closure were compared with those of patients whose skin wound was left open to heal by secondary intention. The association between skin closure and SSI was evaluated using propensity score-adjusted multivariable logistic regression.


RESULTS
Of 510 patients who underwent DCL, primary fascial closure was achieved in 301. Among these, 111 (36.9 per cent) underwent primary skin closure and in 190 (63.1 per cent) the skin wound was left open. Fascial closure at the initial take-back surgery was associated with having skin closure (P < 0.001), and colonic injury was associated with leaving the skin open (P = 0.002). On multivariable analysis, primary skin closure was associated with an increased risk of abdominal SSI (P = 0.020), but not fascial dehiscence (P = 0.446). Of patients receiving skin closure, 85.6 per cent did not develop abdominal SSI and were spared the morbidity of managing an open wound at discharge.


CONCLUSIONS
Primary skin closure after DCL is appropriate but may be associated with an increased risk of SSI.
Department of Surgery, University of Texas Medical School at Houston, Houston, Texas, USA; Center for Translational Injury Research, University of Texas Medical School at Houston, Houston, Texas, USA; Center for Surgical Trials and Evidence Based Practice, University of Texas Medical School at Houston, Houston, Texas, USA.
M J
MJ
Pommerening
L S
LS
Kao
K J
KJ
Sowards
C E
CE
Wade
J B
JB
Holcomb
B A
BA
Cotton
D000007:Abdominal Injuries / Q000601:surgery; D000328:Adult; D006801:Humans; D007813:Laparotomy / Q000009:adverse effects / Q000379:methods*; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000517:prevention & control*; D016896:Treatment Outcome; D058106:Wound Closure Techniques; D014949:Wounds, Nonpenetrating / Q000601:surgery; D055815:Young Adult