Damage Control in Trauma

Laparotomy Wound Management Acute to Chronic

Timothy C. Fabian

Research output: Contribution to journalReview article

52 Citations (Scopus)

Abstract

Damage control surgery has become a fundamental component of operative trauma care. It undoubtedly has saved many lives that would have been lost in the not-too-distant past. In the development of these techniques, a great deal has been learned about intra-abdominal hypertension and ACS. Prophylactic application of open abdomen techniques evolved and led to avoidance of a great deal of the organ dysfunction associated with ACS. Additionally, in years past, many wounds were closed under considerable tension in the face of contamination that resulted in a high rate of necrotizing fasciitis, intestinal fistulization, and significant mortalities attributed to those dire complications. Surgeons now are learning a great deal about management of large open abdominal wounds. A wide variety of techniques has been adopted, but as time passes, there seems to be a general consensus developing regarding acute management of these wounds. Most institutions are adopting staged techniques of management similar to that described. It is recognized that getting the open wound closed as soon as possible leads to fewer complications, including lower fistula rates. The acute use of vacuum wound dressings is promising in that it may provide for early secondary closure of a significant portion these patients. Although we are continuing to learn about acute management, there has been less study focused on optimal definitive reconstructive techniques. The modified component separation technique has provided good results, with low recurrent hernia rates and long-term functional abdominal wall dynamics. Recently, the use of biomaterials for acute and chronic reconstruction shows promise in this area. Further focus and study in all of these areas ultimately will lead to improved outcomes in this most seriously injured cohort of trauma patients.

Original languageEnglish (US)
Pages (from-to)73-93
Number of pages21
JournalSurgical Clinics of North America
Volume87
Issue number1
DOIs
StatePublished - Feb 1 2007

Fingerprint

Laparotomy
Wounds and Injuries
Intra-Abdominal Hypertension
Necrotizing Fasciitis
Biocompatible Materials
Abdominal Wall
Bandages
Hernia
Vacuum
Abdomen
Fistula
Consensus
Learning
Mortality

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

Damage Control in Trauma : Laparotomy Wound Management Acute to Chronic. / Fabian, Timothy C.

In: Surgical Clinics of North America, Vol. 87, No. 1, 01.02.2007, p. 73-93.

Research output: Contribution to journalReview article

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