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Complications after 344 damage-control open celiotomies
Richard S Miller1, John A Morris, Jose J Diaz
1Section of Surgical Sciences, Division of Trauma and Surgical Critical Care, Vanderbilt University Medical Center, Nashville, Tennessee 37212, USA. richard.miller@vanderbilt.edu
The Journal of Trauma
|January 6, 2006
Summary
Delayed wound closure after open abdomen surgery significantly reduces complications. Early fascial closure within eight days improves outcomes and lowers costs for trauma patients.
Area of Science:
- Trauma Surgery
- Surgical Outcomes
- Wound Management
Background:
- Open abdomen management is associated with high wound complication rates.
- The timing and method of wound closure may influence these complication rates.
Purpose of the Study:
- To investigate the relationship between wound closure timing/methods and complication rates in open abdomen cases.
- To identify optimal strategies for reducing morbidity and healthcare charges.
Main Methods:
- Retrospective review of trauma patients (1995-2002) requiring open abdomen and temporary coverage.
- Classification of survivors by wound closure method: primary fascial closure, temporizing (skin only/mesh), or prosthetic (mesh).
Main Results:
- 25% of patients (69/276) experienced wound complications; 7 deaths were directly related.
- Complications significantly increased when fascial closure was delayed beyond 8 days (p < 0.0001).
- Primary fascial closure resulted in fewer transfusions, shorter closure times, lower complication rates, and reduced initial hospitalization charges compared to other methods.
Conclusions:
- High morbidity persists with open abdomen wound complications (25%).
- Wound closure timing, method, and transfusion volume impact morbidity, independent of injury severity.
- Delayed primary fascial closure before 8 days is linked to superior outcomes and cost-effectiveness.