Critical Decision Points in Managing the Open Abdomen

  • Nathan T. Mowery
  • John A. MorrisJr.

The outcome of the Damage Control Surgery (DCS) patient is equally dependent on decisions made at the initial operation and on a variety of post-operative decisions.


Abdominal Compartment Syndrome Damage Control Open Abdomen Fascial Closure Abdominal Closure 
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  1. 1.
    Morris JA, Jr., Eddy VA, Blinman TA, Rutherford EJ, Sharp KW. The staged celiotomy for trauma. Issues in unpacking and reconstruction. Ann Surg 1993; 217(5):576–584CrossRefPubMedGoogle Scholar
  2. 2.
    Hoyt DB, Bulger EM, Knudson MM et al. Death in the operating room: An analysis of a multi-center experience. J Trauma 1994; 37(3):426–432CrossRefPubMedGoogle Scholar
  3. 3.
    Rotondo MF, Schwab CW, McGonigal MD, Phillips GR III, Fruchterman TM, Kauder DR, Latenser BA, Angood PA. “Damage control”: An approach for improved survival in exsanguinating penetrating abdominal injury. J Trauma 1993; 35(3):375–382CrossRefPubMedGoogle Scholar
  4. 4.
    Abramson D, Scalea TM, Hitchcock R, Trooskin SZ, Henry SM, Greenspan J. Lactate clearance and survival following injury. J Trauma 1993; 35(4):584–588CrossRefPubMedGoogle Scholar
  5. 5.
    Baker WF, Jr. Clinical aspects of disseminated intravascular coagulation: A clinician’s point of view. Semin Thromb Hemost 1989; 15(1):1–57CrossRefPubMedGoogle Scholar
  6. 6.
    Davis JW, Shackford SR, Mackersie RC, Hoyt DB. Base deficit as a guide to volume resuscitation. J Trauma 1988; 28(10):1464–1467CrossRefPubMedGoogle Scholar
  7. 7.
    Harrigan C, Lucas CE, Ledgerwood AM. The effect of hemorrhagic shock on the clotting cascade in injured patients. J Trauma 1989; 29(10):1416–1421CrossRefPubMedGoogle Scholar
  8. 8.
    Jurkovich GJ, Greiser WB, Luterman A, Curreri PW. Hypothermia in trauma victims: An ominous predictor of survival. J Trauma 1987; 27(9):1019–1024CrossRefPubMedGoogle Scholar
  9. 9.
    Luna GK, Maier RV, Pavlin EG, Anardi D, Copass MK, Oreskovich MR. Incidence and effect of hypothermia in seriously injured patients. J Trauma 1987; 27(9):1014–1018CrossRefPubMedGoogle Scholar
  10. 10.
    McClelland RN, Shires GT, Baxter CR, Coln CD, Carrico J. Balanced salt solution in the treatment of hemorrhagic shock. Studies in dogs. JAMA 1967; 199(11):830–834Google Scholar
  11. 11.
    Shapiro MB, Jenkins DH, Schwab CW, Rotondo MF. Damage control: Collective review. J Trauma 2000; 49(5):969–978CrossRefPubMedGoogle Scholar
  12. 12.
    Sharp KW, Locicero RJ. Abdominal packing for surgically uncontrollable hemorrhage. Ann Surg 1992; 215(5):467–474CrossRefPubMedGoogle Scholar
  13. 13.
    Valeri CR, Feingold H, Cassidy G, Ragno G, Khuri S, Altschule MD. Hypothermia-induced reversible platelet dysfunction. Ann Surg 1987; 205(2):175–181CrossRefPubMedGoogle Scholar
  14. 14.
    Johnson JW, Gracias VH, Schwab CW, Reilly PM, Kauder DR, Dabrowski GP, Shapiro MB, Rotondo MF. Evolution in damage control for exsanguinating penetrating abdominal injury. J Trauma 2001; 51(2):261–269CrossRefPubMedGoogle Scholar
  15. 15.
    Patt A, McCroskey BL, Moore EE. Hypothermia-induced coagulopathies in trauma. Surg Clin North Am 1988; 68(4):775–785PubMedGoogle Scholar
  16. 16.
    Gentilello LM, Cortes V, Moujaes S, Viamonte M, Malinin TL, Ho CH, Gomez GA. Continuous arteriovenous rewarming: Experimental results and thermodynamic model simulation of treatment for hypothermia. J Trauma 1990; 30(12):1436–1449CrossRefPubMedGoogle Scholar
  17. 17.
    Demetriades D, Hadjizacharia P, Constantinou C, Brown C, Inaba K, Rhee P, Salim A. Selective nonoperative management of penetrating abdominal solid organ injuries. Ann Surg 2006; 244(4):620–628PubMedGoogle Scholar
  18. 18.
    Velmahos GC, Toutouzas KG, Radin R, Chan L, Demetriades D. Nonoperative treatment of blunt injury to solid abdominal organs: A prospective study. Arch Surg 2003; 138(8):844–851CrossRefPubMedGoogle Scholar
  19. 19.
    Panetta T, Sclafani SJ, Goldstein AS, Phillips TF, Shaftan GW. Percutaneous transcatheter embolization for massive bleeding from pelvic fractures. J Trauma 1985; 25(11):1021–1029PubMedGoogle Scholar
  20. 20.
    Velmahos GC, Chahwan S, Hanks SE, Murray JA, Berne TV, Asensio J, Demetriades D. Angiographic embolization of bilateral internal iliac arteries to control life-threatening hemorrhage after blunt trauma to the pelvis. Am Surg 2000; 66(9):858–862PubMedGoogle Scholar
  21. 21.
    Panetta T, Sclafani SJ, Goldstein AS, Phillips TF. Percutaneous transcatheter embolization for arterial trauma. J Vasc Surg 1985; 2(1):54–64CrossRefPubMedGoogle Scholar
  22. 22.
    Aksoy M, Taviloglu K, Yanar H, Poyanli A, Ertekin C, Rozanes I, Guloglu R, Kurtoglu M. Percutaneous transcatheter embolization in arterial injuries of the lower limbs. Acta Radiol 2005; 46(5):471–475CrossRefPubMedGoogle Scholar
  23. 23.
    Velmahos GC, Demetriades D, Chahwan S, Gomez H, Hanks SE, Murray JA, Asensio JA, Berne TV. Angiographic embolization for arrest of bleeding after penetrating trauma to the abdomen. Am J Surg 1999; 178(5):367–373CrossRefPubMedGoogle Scholar
  24. 24.
    Johnson JW, Gracias VH, Gupta R, Guillamondegui O, Reilly PM, Shapiro MB, Kauder DR, Schwab CW. Hepatic angiography in patients undergoing damage control laparotomy. J Trauma 2002; 52(6):1102–1106CrossRefPubMedGoogle Scholar
  25. 25.
    Mayberry JC. Bedside open abdominal surgery. Utility and wound management. Crit Care Clin 2000; 16(1):151–172Google Scholar
  26. 26.
    Diaz JJ, Jr., Mauer A, May AK, Miller R, Guy JS, Morris JA, Jr. Bedside laparotomy for trauma: Are there risks? Surg Infect (Larchmt) 2004; 5(1):15–20CrossRefGoogle Scholar
  27. 27.
    Moore EE, Burch JM, Franciose RJ, Offner PJ, Biffl WL. Staged physiologic restoration and damage control surgery. World J Surg 1998; 22(12):1184–1190CrossRefPubMedGoogle Scholar
  28. 28.
    Demetriades D, Murray JA, Chan L, Ordonez C, Bowley D, Nagy KK, Cornwell EE, Velmahos GC, Munoz N, Hatzitheofilou C, Schwab CW, Rodriguez A, Cornejo C, Davis KA, Namias N, Wisner DH, Ivatury RR, Moore EE, Acosta JA, Maull KI, Thomason MH, Spain DA. Penetrating colon injuries requiring resection: Diversion or primary anastomosis? An AAST prospective multicenter study. J Trauma 2001; 50(5):765–775CrossRefPubMedGoogle Scholar
  29. 29.
    Murray JA, Demetriades D, Colson M, Song Z, Velmahos GC, Cornwell III EE, Asensio JA, Belzberg H, Berne TV. Colonic resection in trauma: Colostomy versus anastomosis. J Trauma 1999; 46(2):250–254CrossRefPubMedGoogle Scholar
  30. 30.
    Sasaki LS, Allaben RD, Golwala R, Mittal VK. Primary repair of colon injuries: A prospective randomized study. J Trauma 1995; 39(5):895–901CrossRefPubMedGoogle Scholar
  31. 31.
    Sasaki LS, Mittal V, Allaben RD. Primary repair of colon injuries: A retrospective analysis. Am Surg 1994; 60(7):522–527PubMedGoogle Scholar
  32. 32.
    Gonzalez RP, Merlotti GJ, Holevar MR. Colostomy in penetrating colon injury: Is it necessary? J Trauma 1996; 41(2):271–275CrossRefPubMedGoogle Scholar
  33. 33.
    Miller PR, Chang MC, Hoth JJ, Holmes JH, Meredith JW. Colonic resection in the setting of damage control laparotomy: Is delayed anastomosis safe? Am Surg 2007; 73(6):606–609PubMedGoogle Scholar
  34. 34.
    Miller RS, Morris JA, Jr., Diaz JJ, Jr., Herring MB, May AK. Complications after 344 damage-control open celiotomies. J Trauma 2005; 59(6):1365–1371CrossRefPubMedGoogle Scholar
  35. 35.
    Asensio JA, McDuffie L, Petrone P, Roldan G, Forno W, Gambaro E, Salim A, Demetriades D, Murray J, Velmahos G, Shoemaker W, Berne TV, Ramicone E, Chan L, Biffl WL. Reliable variables in the exsanguinated patient which indicate damage control and predict outcome. Am J Surg 2001; 182(6):743–751CrossRefPubMedGoogle Scholar
  36. 36.
    Asensio JA, Petrone P, Roldan G, Kuncir E, Ramicone E, Chan L. Has evolution in awareness of guidelines for institution of damage control improved outcome in the management of the posttraumatic open abdomen? Arch Surg 2004; 139(2):209–214CrossRefPubMedGoogle Scholar
  37. 37.
    Stone PA, Hass SM, Flaherty SK, Deluca JA, Lucente FC, Kusminsky RE. Vacuum-assisted fascial closure for patients with abdominal trauma. J Trauma 2004; 57(5):1082–1086CrossRefPubMedGoogle Scholar
  38. 38.
    Miller PR, Meredith JW, Johnson JC, Chang MC. Prospective evaluation of vacuum-assisted fascial closure after open abdomen: Planned ventral hernia rate is substantially reduced. Ann Surg 2004; 239(5):608–614CrossRefPubMedGoogle Scholar
  39. 39.
    Bishop MH, Shoemaker WC, Appel PL, Meade P, Ordog GJ, Wasserberger J, Wo C-J, Rimle DA, Kram HB, Umali R, Kennedy F, Shuleshko J, Stephen CM, Shori SK, Thadepalli HD. Prospective, randomized trial of survivor values of cardiac index, oxygen delivery, and oxygen consumption as resuscitation endpoints in severe trauma. J Trauma 1995; 38(5):780–787CrossRefPubMedGoogle Scholar
  40. 40.
    Scalea TM, Simon HM, Duncan AO, Atweh NA, Sclafani SA, Phillips TF, Shaftan GW. Geriatric blunt multiple trauma: Improved survival with early invasive monitoring. J Trauma 1990; 30(2):129–134CrossRefPubMedGoogle Scholar
  41. 41.
    Martin GS, Moss M, Wheeler AP, Mealer M, Morris JA, Bernard GR. A randomized, controlled trial of furosemide with or without albumin in hypoproteinemic patients with acute lung injury. Crit Care Med 2005; 33(8):1681–1687CrossRefPubMedGoogle Scholar
  42. 42.
    Martin GS, Mangialardi RJ, Wheeler AP, Dupont WD, Morris JA, Bernard GR. Albumin and furosemide therapy in hypoproteinemic patients with acute lung injury. Crit Care Med 2002; 30(10):2175–2182CrossRefPubMedGoogle Scholar
  43. 43.
    Balogh Z, McKinley BA, Cocanour CS, Kozar RA, Valdivia A, Sailors RM, Moore FA. Supranormal trauma resuscitation causes more cases of abdominal compartment syndrome. Arch Surg 2003; 138(6):637–642CrossRefPubMedGoogle Scholar
  44. 44.
    Vogel TR, Diaz JJ, Miller RS, May AK, Guillamondegui OD, Guy JS, Morris JA. The open abdomen in trauma: Do infectious complications affect primary abdominal closure? Surg Infect (Larchmt) 2006; 7(5):433–441CrossRefGoogle Scholar
  45. 45.
    Ramirez OM, Ruas E, Dellon AL. “Components separation” method for closure of abdominal-wall defects: An anatomic and clinical study. Plast Reconstr Surg 1990; 86(3):519–526CrossRefPubMedGoogle Scholar
  46. 46.
    Vargo D. Component separation in the management of the difficult abdominal wall. Am J Surg 2004; 188(6):633–637CrossRefPubMedGoogle Scholar
  47. 47.
    Fabian TC, Croce MA, Pritchard FE, Minard G, Hickerson WL, Howell RL, Schurr MJ, Kudsk KA. Planned ventral hernia. Staged management for acute abdominal wall defects. Ann Surg 1994; 219(6):643–650Google Scholar
  48. 48.
    Brandt CP, McHenry CR, Jacobs DG, Piotrowski JJ, Priebe PP. Polypropylene mesh closure after emergency laparotomy: Morbidity and outcome. Surgery 1995; 118(4):736–740CrossRefPubMedGoogle Scholar
  49. 49.
    Fansler RF, Taheri P, Cullinane C, Sabates B, Flint LM. Polypropylene mesh closure of the complicated abdominal wound. Am J Surg 1995; 170(1):15–18CrossRefPubMedGoogle Scholar
  50. 50.
    Voyles CR, Richardson JD, Bland KI, Tobin GR, Flint LM, Polk HC, Jr. Emergency abdominal wall reconstruction with polypropylene mesh: Short-term benefits versus long-term complications. Ann Surg 1981; 194(2):219–223CrossRefPubMedGoogle Scholar
  51. 51.
    Dayton MT, Buchele BA, Shirazi SS, Hunt LB. Use of an absorbable mesh to repair contaminated abdominal-wall defects. Arch Surg 1986; 121(8):954–960PubMedGoogle Scholar
  52. 52.
    Mayberry JC, Burgess EA, Goldman RK, Pearson TE, Brand D, Mullins RJ. Enterocutaneous fistula and ventral hernia after absorbable mesh prosthesis closure for trauma: The plain truth. J Trauma 2004; 57(1):157–162CrossRefPubMedGoogle Scholar
  53. 53.
    Patton JH, Jr., Berry S, Kralovich KA. Use of human acellular dermal matrix in complex and contaminated abdominal wall reconstructions. Am J Surg 2007; 193(3):360–363CrossRefPubMedGoogle Scholar
  54. 54.
    Kim H, Bruen K, Vargo D. Acellular dermal matrix in the management of high-risk abdominal wall defects. Am J Surg 2006; 192(6):705–709CrossRefPubMedGoogle Scholar
  55. 55.
    Scott BG, Welsh FJ, Pham HQ, Carrick MM, Liscum KR, Granchi TS, Wall MJ, Mattox KL, Hirshberg A. Early aggressive closure of the open abdomen. J Trauma 2006; 60(1):17–22CrossRefPubMedGoogle Scholar
  56. 56.
    Gupta A, Zahriya K, Mullens PL, Salmassi S, Keshishian A. Ventral herniorrhaphy: Experience with two different biosynthetic mesh materials, Surgisis and Alloderm. Hernia 2006; 10(5):419–425CrossRefPubMedGoogle Scholar
  57. 57.
    Jernigan TW, Fabian TC, Croce MA, Moore N, Pritchard FE, Minard G, Bee TK. Staged management of giant abdominal wall defects: Acute and long-term results. Ann Surg 2003; 238(3):349–355PubMedGoogle Scholar
  58. 58.
    Fabian TC. Damage control in trauma: Laparotomy wound management acute to chronic. Surg Clin North Am 2007; 87(1):73–93, viGoogle Scholar
  59. 59.
    Fabian TC. Damage control in trauma: Laparotomy wound management acute to chronic. Surg Clin North Am 2007; 87(1):73–93, viGoogle Scholar
  60. 60.
    Sutton E, Bochicchio GV, Bochicchio K, Rodriguez ED, Henry S, Joshi M, Scalea TM. Long term impact of damage control surgery: A preliminary prospective study. J Trauma 2006; 61(4):831–834CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  1. 1.Department of SurgeryWake Forest University, Medical Center BoulevardUSA

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