[Risk factors and algorithm for choosing abdominal closure strategy in staged treatment of penetrating wounds]
I V Paharev1, V I Badalov1, A V Goncharov1
1Kirov Military Medical Academy, St. Petersburg, Russia.
Objective:
To analyze the influence of local and systemic factors on reparative processes of laparotomy wound for optimized choice of abdominal closure strategy.
Material And Methods:
A retrospective analysis enrolled 62 patients with penetrating abdominal wounds. Local (intra-abdominal complications, risk of abdominal compartment syndrome, number of relaparotomies) and systemic (total blood protein and urea) factors were assessed.
Results:
Statistical analysis revealed predictors of suture failure. Independent risk factors of aponeurotic suture failure were serum urea (odds ratio 0.754; p=0.020) and total protein (odds ratio 1.195; p=0.028) upon abdominal closure. Local factors (surgical site infection, peritonitis, abdominal compartment syndrome) were absolutely associated with failure (p<0.001).
Conclusion:
A formalized algorithm consistently evaluates local factors and serum protein/urea with high predictive value of positive result (91.11%). Original algorithm objectifies the choice of abdominal closure strategy (primary suturing, controlled negative pressure or programmable hernia) and minimizes the risk of suture failure.
