Preclinical Evaluation of the Alexis Retractor as a Temporary Abdominal Closure Device in Damage Control Surgery...

Temporary abdominal closure (TAC) is a critical component of damage control surgery. Negative pressure wound therapy (NPWT), particularly when combined with continuous fascial traction, is regarded as the preferred TAC strategy because of improved delayed fascial closure rates. However, dedicated equipment, consumables, and technical expertise may be unavailable in military, humanitarian, mass-casualty, or resource-limited settings, where simpler techniques such as the Bogotá bag remain relevant. The Alexis retractor provides circumferential retraction and wound-edge protection but has not previously been evaluated as a TAC technique. A prospective comparative Dead Tissue Training (DTT) study was conducted using 12 porcine cadaver models. Twenty-nine participants from a multidisciplinary DCS group performed TAC with the Bogotá bag and Alexis retractor after standardized instruction. The primary outcome was application time; secondary outcomes were perceived difficulty, need for assistance, estimated training requirements, and preference. Mean application time was shorter with the Alexis retractor than with the Bogotá bag (122.1 ± 45.3 s versus 573.3 ± 265.5 s; p < 0.01). Median perceived difficulty was also lower (2.0 versus 6.0 on a 0-10 scale; p < 0.01). Thirteen participants required no assistance, 10 required assistance only for the Bogotá bag, and 6 required assistance for both (p = 0.02). Most participants reported one training session was sufficient for the Alexis retractor, and estimated training requirements differed between techniques (p = 0.012). Most preferred the Alexis retractor. In this preclinical model, the Alexis retractor demonstrated procedural advantages over the Bogotá bag, including faster application, lower perceived difficulty, reduced need for assistance, and lower estimated training requirements. It may represent a rapidly deployable TAC option when NPWT is unavailable or impractical, but it should not be regarded as a substitute for guideline-recommended NPWT-based strategies. Clinical studies are required to evaluate visceral safety, fascial closure, leakage, infection, and patient outcomes.