Damage control surgery and open abdomen in trauma patients with exsanguinating bleeding

Area of Science:

• Trauma Surgery
• Surgical Critical Care
• Emergency Medicine

Background:

• Exsanguinating bleeding in trauma is associated with high mortality.
• Conventional management often proves insufficient for severe bleeding trauma.
• Damage control surgery (DCS) and open abdomen techniques have emerged as life-saving interventions.

Purpose of the Study:

• To evaluate the effectiveness of DCS and open abdomen management in blast victims with exsanguinating bleeding.
• To assess the outcomes of temporary abdominal closure methods like V.A.C. and VP.
• To determine factors influencing survival in severe trauma cases.

Main Methods:

• Retrospective analysis of 12 consecutive blast victims undergoing DCS and open abdomen.
• Utilized Vacuum Assisted Closure (V.A.C.) and vacuum packing (VP) for temporary abdominal closure.
• Performed a cumulative analysis of relevant series from 2000-2013.

Main Results:

• DCS was applied in 10.5% of blast victims, with an overall survival rate of 66.7%.
• Temporary abdominal closure with V.A.C. or VP was used in 11 patients.
• Primary fascial closure was achieved in 85.7% of survivors, with V.A.C. and VP demonstrating efficacy.

Conclusions:

• DCS and open abdomen management offer significant survival benefits for trauma patients with exsanguinating bleeding.
• Rapid implementation of DCS in selected patients is crucial for improving survival rates.
• V.A.C. and VP are effective methods for achieving primary fascial closure in trauma patients.