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Pediatric vacuum packing wound closure for damage-control laparotomy
Michele A Markley1, P Cameron Mantor, Robert W Letton
1Section of Pediatric Surgery, Department of Surgery, The University of Oklahoma College of Medicine, Oklahoma City, OK, USA.
Insights
Vacuum packing (Vac-Pac) effectively manages pediatric open abdomens. A novel corset closure technique facilitates fascial approximation, potentially eliminating skin grafts for severe abdominal injuries.
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.
Background/Purpose:
Recent studies advocate the use of the open-abdomen technique for managing the abdominal compartment syndrome and uncontrolled intraperitoneal sepsis. The authors have used vacuum packing (Vac-Pac) in pediatric patients with excellent results and have developed a method for closing widely distracted fascial edges to avoid the need for skin grafting.
Methods:
Patients who had an intraabdominal catastrophe best managed by a temporary open-abdomen technique were included. After damage control laparotomy, the Vac-Pac temporary closure was used. In 2 patients a corsetlike lacing was used to bring the widely separated fascial edges together gradually.
Results:
Five patients with intraabdominal sepsis and one with the abdominal compartment syndrome were included. The length of time the Vac-Pac was used ranged from 3 to 21 days. In 2 patients, the corset closure allowed wound approximation within 5 to 7 days. One patient died of overwhelming sepsis, the remainder of the patients survived.
Conclusions:
The Vac-Pac technique for abdominal closure is a simple and inexpensive means by which to manage the open abdomen in the pediatric patient effectively. Use of a corset-type closure for wounds with widely distracted edges should eliminate the need for skin grafting over an open abdomen.