Early fascial closure of the damage control abdomen in children
Myrick C Shinall1, Kaushik Mukherjee, Harold N Lovvorn
1Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Insights
Early abdominal wall closure in children using human acellular dermal matrix (HADM) after damage control surgery can prevent ventral hernias. This approach may reduce complications associated with delayed closure techniques.
Area of Science:
- Pediatric Surgery
- Abdominal Wall Reconstruction
- Biomaterials in Surgery
Background:
- Traditional damage control abdomen management often leads to ventral hernias and requires delayed reconstruction.
- Delayed closure increases the risk of complications in pediatric patients with intra-abdominal catastrophes.
Purpose of the Study:
- To evaluate the efficacy of early fascial closure using human acellular dermal matrix (HADM) in pediatric patients undergoing damage control celiotomy.
- To assess the potential benefits of HADM in minimizing complications and the need for further surgical procedures.
Main Methods:
- A retrospective review of five pediatric patients who underwent damage control celiotomy for intra-abdominal catastrophes.
- Early definitive abdominal closure was achieved using HADM as a fascial substitute, with skin and subcutaneous layers approximated over drains.
Main Results:
- The study included five patients aged 1 month to 19 years with diverse intra-abdominal catastrophes.
- Early closure with HADM was performed 6–9 days post-celiotomy; one patient had a superficial wound infection, but no ventral hernias developed.
Conclusions:
- Early abdominal wall closure with HADM in pediatric damage control surgery appears to be a viable option.
- This technique may reduce the incidence of ventral hernias and complications linked to delayed abdominal closure.
Abstract:
Traditional staged closure of the damage control abdomen frequently results in a ventral hernia, need for delayed abdominal wall reconstruction, and risk of multiple complications. We examined the potential benefits in children of early fascial closure of the damage control abdomen using human acellular dermal matrix (HADM). We reviewed our experience with five consecutive children sustaining intra-abdominal catastrophe and managed with damage control celiotomy. To accomplish early definitive abdominal closure, HADM was sewn in place as a fascial substitute; the skin and subcutaneous layers were approximated over silicone drains. The five patients ranged in age from 1 month to 19 years at the time of presentation. Intra-abdominal catastrophes included complex bowel injuries after blunt trauma in two children, necrotizing pancreatitis and gastric perforation in one teenager, necrotizing enterocolitis in one premature infant, and perforated typhlitis in one adolescent. All damage control wounds were dirty. Time range from initial celiotomy to definitive abdominal closure was 6 to 9 days. After definitive closure, one child developed a superficial wound infection. No patient developed a ventral hernia. After damage control celiotomy in children, early abdominal wall closure using HADM may minimize comq plications associated with delayed closure techniques and the need for additional procedures.
