Primary skin closure after damage control laparotomy

Damage control laparotomy (DCL) is used widely in the management of patients with traumatic injuries but carries significant morbidity. Surgical-site infection (SSI) also carries potential morbidity, increased costs and prolonged hospital stay. The aim of this study was to determine whether primary skin closure after DCL increases the risk of SSI.

This was a retrospective institutional review of injured patients undergoing DCL between 2004 and 2012. Outcomes of patients who had primary skin closure at the time of fascial closure were compared with those of patients whose skin wound was left open to heal by secondary intention. The association between skin closure and SSI was evaluated using propensity score-adjusted multivariable logistic regression.

Of 510 patients who underwent DCL, primary fascial closure was achieved in 301. Among these, 111 (36.9 per cent) underwent primary skin closure and in 190 (63.1 per cent) the skin wound was left open. Fascial closure at the initial take-back surgery was associated with having skin closure (P < 0.001), and colonic injury was associated with leaving the skin open (P = 0.002). On multivariable analysis, primary skin closure was associated with an increased risk of abdominal SSI (P = 0.020), but not fascial dehiscence (P = 0.446). Of patients receiving skin closure, 85.6 per cent did not develop abdominal SSI and were spared the morbidity of managing an open wound at discharge.

Primary skin closure after DCL is appropriate but may be associated with an increased risk of SSI.