title: Abbreviated closure for remote damage control laparotomy in extreme environments: A randomized trial of sutures versus wound clamps comparing terrestrial and weightless conditions.
abstract: BACKGROUND
  Far-Forward Damage Control Laparotomies (DCLs) might provide direct-compression of visceral hemorrhage, however, suturing is a limiting factor, especially for non-physicians. We thus compared abbreviated skin closures comparing skin-suture (SS) versus wound-clamp (WC), on-board a research aircraft in weightlessness (0g) and normal gravity (1g).
  
  
  METHODS
  Surgeons conducted DCLs on a surgical-simulator; onboard the hangered-aircraft (1g), or during parabolic flight (0g), randomized to either WC or SS.
  
  
  RESULTS
  Ten surgeons participated. Two (40%) surgeons randomized to suture in 0g were incapacitated with motion-sickness, and none were able to close in either 1 or 0g. With WC, two completely closed in 1g as did three in 0g, despite having longer incisions (p = 0.016). Overall skin-closure with WC was significantly greater in both 1g (p = 0.016) and 0g (p = 0.008).
  
  
  CONCLUSIONS
  WC was more effective in 1g and particularly 0g. Future studies should address the utility of abbreviated WC abdominal closure to facilitate potential Far-Forward DCL.
  
  
  BACKGROUND
  ID ISRCTN/77929274.
authors.affiliation: Canadian Forces Health Services, Nationwide, Canada; Department of Surgery, University of Calgary, Calgary, AB, Canada; Department of Critical Care Medicine, University of Calgary, Calgary, AB, Canada; The Regional Trauma Services Foothills Medical Centre, University of Calgary, Calgary, AB, Canada; University of Calgary, Calgary, AB, Canada. Electronic address: Andrew.kirkpatrick@albertahealthservices.ca.
authors.forename: Andrew W
authors.initials: AW
authors.lastname: Kirkpatrick
authors.affiliation: Innovative Trauma Care, Edmonton, AB, Canada.
authors.forename: Jessica Lynn
authors.initials: JL
authors.lastname: McKee
authors.affiliation: Canadian Forces Health Services, Nationwide, Canada; Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
authors.forename: Colonel Homer
authors.initials: CH
authors.lastname: Tien
authors.affiliation: Rocky Vista University School of Medicine, CO, USA.
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: LaPorta
authors.affiliation: Strategic Operations, San Diego, CA, USA.
authors.forename: Kit
authors.initials: K
authors.lastname: Lavell
authors.affiliation: Flight Research Laboratory, National Research Council of Canada, Ottawa, ON, Canada.
authors.forename: Tim
authors.initials: T
authors.lastname: Leslie
authors.affiliation: Department of Surgery, University of Calgary, Calgary, AB, Canada; Department of Critical Care Medicine, University of Calgary, Calgary, AB, Canada; The Regional Trauma Services Foothills Medical Centre, University of Calgary, Calgary, AB, Canada; University of Calgary, Calgary, AB, Canada.
authors.forename: Paul B
authors.initials: PB
authors.lastname: McBeth
authors.affiliation: Department of Surgery, University of Calgary, Calgary, AB, Canada; University of Calgary, Calgary, AB, Canada.
authors.forename: Derek J
authors.initials: DJ
authors.lastname: Roberts
authors.affiliation: Department of Surgery, University of Calgary, Calgary, AB, Canada; The Regional Trauma Services Foothills Medical Centre, University of Calgary, Calgary, AB, Canada; University of Calgary, Calgary, AB, Canada.
authors.forename: Chad G
authors.initials: CG
authors.lastname: Ball
mesh_terms: D058107:Abdominal Wound Closure Techniques / Q000295:instrumentation; D000328:Adult; D000071251:Extreme Environments; D006801:Humans; D007813:Laparotomy; D008297:Male; D008953:Models, Anatomic; D013536:Suture Techniques / Q000295:instrumentation; D014893:Weightlessness
keywords: Damage control surgery; Exsanguination; Operational medicine; Surgical simulation; Tactical medicine