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Related Experiment Videos

Covering the "open abdomen": a better technique

J Sherck1, A Seiver, C Shatney

  • 1Department of Surgery, Stanford University Medical School and Santa Clara Valley Medical Center, San Jose, California 95128, USA.

The American Surgeon
|September 10, 1998
PubMed
Summary

This study presents a sutureless technique for temporary abdominal coverage in critical cases, utilizing adhesive plastic sheeting. This safe and effective method manages the open abdomen, preventing complications and facilitating later closure.

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Area of Science:

  • Surgical Innovation
  • Trauma Surgery
  • Critical Care Medicine

Background:

  • Severe abdominal trauma, compartment syndrome, and necrotizing infections often necessitate leaving the abdominal fascia open after laparotomy.
  • Existing temporary visceral coverage techniques have reported significant issues.
  • The management of the open abdomen remains a challenge in critical surgical care.

Purpose of the Study:

  • To evaluate the efficacy and safety of a novel, sutureless temporary abdominal coverage technique.
  • To assess the outcomes of patients managed with adhesive plastic sheeting for open abdomens.
  • To establish a reliable method for temporary abdominal wall closure in complex surgical cases.

Main Methods:

  • A sutureless technique involving omental coverage, clear plastic sheeting, sump drains, and iodophor-impregnated adhesive plastic drapes was employed.

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  • The technique was applied to 50 patients with indications including severe abdominal trauma, necrotizing fasciitis, and pancreatitis.
  • Data on wound complications, bowel obstruction, and mortality were collected and analyzed.

    • Main Results:

    • The technique was successfully used in 50 patients, with severe abdominal trauma being the most common indication (27 patients).
    • No instances of wound infection, necrotizing fasciitis, or bowel obstruction were observed.
    • Eighteen patients died, but none of the deaths were attributed to the abdominal closure method.

    Conclusions:

    • Temporary abdominal coverage with adhesive plastic sheeting is a rapid, safe, and accessible method for managing the open abdomen.
    • This technique creates a physiologic environment for viscera, simplifies nursing care, and aids in eventual abdominal closure.
    • The sutureless adhesive sheeting method offers a viable solution for complex abdominal wall management in critically ill patients.