Pediatric vacuum packing wound closure for damage-control laparotomy

Area of Science:

• Pediatric Surgery
• Trauma Management
• Critical Care Medicine

Background:

• Open-abdomen techniques are increasingly used for abdominal compartment syndrome and intraperitoneal sepsis.
• Vacuum packing (Vac-Pac) has shown promise in pediatric cases.
• A method to close widely separated fascial edges is needed to prevent complications like skin grafting.

Purpose of the Study:

• To evaluate the efficacy of the vacuum packing (Vac-Pac) technique for temporary abdominal closure in pediatric patients.
• To present a novel corset-like closure method for managing widely distracted fascial edges in open abdomens.
• To assess the need for skin grafting in pediatric patients undergoing open-abdomen management with Vac-Pac and corset closure.

Main Methods:

• Retrospective review of pediatric patients requiring temporary open-abdomen management.
• Application of vacuum packing (Vac-Pac) after damage control laparotomy.
• Implementation of a corset-like lacing technique for gradual fascial approximation in select cases.

Main Results:

• Six pediatric patients were included (5 with intraabdominal sepsis, 1 with abdominal compartment syndrome).
• Vac-Pac was used for 3 to 21 days.
• Corset closure facilitated wound approximation within 5 to 7 days in 2 patients, avoiding skin grafts. Survival rate was 83%.

Conclusions:

• Vacuum packing (Vac-Pac) offers a simple, cost-effective method for managing the open abdomen in pediatric patients.
• A corset-type closure effectively approximates widely distracted fascial edges, potentially eliminating the need for skin grafting.
• This combined approach improves outcomes in critically ill pediatric surgical patients.