The Difficult Abdominal Wound: Management Tips
- 4 Downloads
Purpose of Review
This review aims to summarize therapeutic options for the management of complex surgical wounds of the abdomen especially in regard to emergency surgery and trauma patients.
Wounds in emergency surgery and trauma patients are complex and have an elevated risk for surgical site infection and hernia. In addition, the open abdomen (OA) and damage control laparotomy (DCL) are techniques being increasingly used not just in trauma patients but in critically ill surgical patients as well. Although these techniques can be lifesaving, they can be complicated and difficult to manage especially in a patient that requires multiple takebacks and those with delayed closures requiring ongoing resuscitation.
This review article discusses the management options that facilitate wound closure and reduce wound complications in an emergency surgery and trauma patient. The article aims to provide a range of options that can be used regardless of resources and surgical expertise.
KeywordsAbdominal wound Open abdomen Damage control laparotomy Temporary abdominal closure
Compliance with Ethical Standards
Conflict of Interest
The author declares no conflicts of interest relevant to this manuscript.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 2.Siribumrungwong B, Chantip A, Noorit P, Wilasrusmee C, Ungpinitpong W, Chotiya P, et al. Comparison of superficial surgical site infection between delayed primary versus primary wound closure in complicated appendicitis: a randomized controlled trial. Ann Surg. 2018;267(4):631–7.CrossRefGoogle Scholar
- 14.• Roberts DJ, Ball CG, Feliciano DV, Moore EE, Ivatury RR, Lucas CE, et al. History of the innovation of damage control for management of trauma patients: 1902–2016. Ann Surg. 2017;265(5):1034–44 (This reference includes a comprehensive history and discussion of the evolution of DCL, describing the pitfalls and lessons over the last 100+ years). CrossRefGoogle Scholar
- 16.• Acosta S, Bjorck M, Petersson U. Vacuum-assisted wound closure and mesh-mediated fascial traction for open abdomen therapy - a systematic review. Anaesthesiol Intensive Ther. 2017;49(2):139–45 (Article demonstrating the importance of early consideration of closure and implementaton of mesh-mediated fascial traction). CrossRefGoogle Scholar
- 17.• Atema JJ, Gans SL, Boermeester MA. Systematic review and meta-analysis of the open abdomen and temporary abdominal closure techniques in non-trauma patients. World J Surg. 2015;39(4):912–25 (This article combines the most recent studies evaluating TAC options in the acute surgical patient). CrossRefGoogle Scholar
- 24.Jairam AP, Timmermans L, Eker HH, Pierik R, van Klaveren D, Steyerberg EW, et al. Prevention of incisional hernia with prophylactic onlay and sublay mesh reinforcement versus primary suture only in midline laparotomies (PRIMA): 2-year follow-up of a multicentre, double-blind, randomised controlled trial. Lancet. 2017;390(10094):567–76.CrossRefGoogle Scholar
- 35.Zielinski MD, Kuntz M, Zhang X, Zagar AE, Khasawneh MA, Zendejas B, et al. Botulinum toxin A-induced paralysis of the lateral abdominal wall after damage-control laparotomy: a multi-institutional, prospective, randomized, placebo-controlled pilot study. J Trauma Acute Care Surg. 2016;80(2):237–42.CrossRefGoogle Scholar