Barker D E, Kaufman H J, Smith L A, Ciraulo D L, Richart C L, Burns R P
Department of Surgery, University of Tennessee College of Medicine, Chattanooga 37403, USA.
J Trauma. 2000 Feb;48(2):201-6; discussion 206-7. doi: 10.1097/00005373-200002000-00001.
Temporary abdominal wound closure after celiotomy for trauma is often desirable. The ideal method of temporary closure should allow rapid closure, easy maintenance, and allow reexploration and wound repair with minimal tissue damage. Over the past 7 years, we have successfully used a vacuum closure system (the vacuum pack) for temporary management of the open abdomen.
Medical records of trauma patients undergoing exploratory celiotomy from April of 1992 to February of 1999 were reviewed. Demographic data as well as indications for open-abdominal management and complications of open-abdominal management were collected.
Two hundred sixteen vacuum packs were performed in 112 trauma patients. Of the 216 vacuum packs placed, 2.8% were placed for increased intra-abdominal pressure, 5.3% for inability to achieve tension-free fascial closure, 20% for damage control, 55% for reexploration, and 16.7% for a combination of factors. Sixty-two patients (55.4%) went on to primary closure and 25 patients (22.3%) underwent polyglactin mesh repair of the defect followed by wound granulation and eventual skin grafting. Twenty-two patients (19.6%) died before abdominal closure was attempted. Five patients (4.5%) developed enterocutaneous fistulae. Five patients (4.5%) developed intra-abdominal abscesses. There were no eviscerations. Three patients (2.7%) required further explorations after abdominal closure. Overall mortality rate was 25.9%, none related to the vacuum pack.
The vacuum pack is the temporary abdominal wound closure of choice in patients undergoing open abdominal management at our institution. Primary closure is achieved in the majority of patients with a low rate of complication. The technique is simple and easily mastered. Technical complications are rare and easily repaired.
剖腹探查术后对创伤患者进行临时性腹部伤口闭合通常是必要的。理想的临时闭合方法应能快速闭合、易于维护，并允许再次探查和伤口修复，同时使组织损伤最小化。在过去7年中，我们成功地使用了一种负压封闭系统（负压包）对开放性腹部进行临时处理。
回顾了1992年4月至1999年2月期间接受剖腹探查术的创伤患者的病历。收集了人口统计学数据以及开放性腹部处理的适应证和开放性腹部处理的并发症。
112例创伤患者共进行了216次负压包处理。在放置的216个负压包中，2.8%是因腹内压升高而放置，5.3%是因无法实现无张力筋膜闭合而放置，20%是用于损伤控制，55%是用于再次探查，16.7%是由于多种因素综合作用。62例患者（55.4%）进行了一期闭合，25例患者（22.3%）对缺损进行了聚乙醇酸网片修复，随后伤口肉芽生长并最终进行了植皮。22例患者（19.6%）在尝试腹部闭合前死亡。5例患者（4.5%）发生肠皮肤瘘。5例患者（4.5%）发生腹腔内脓肿。没有发生脏器脱出。3例患者（2.7%）在腹部闭合后需要进一步探查。总体死亡率为25.9%，均与负压包无关。
在我们机构接受开放性腹部处理的患者中，负压包是临时性腹部伤口闭合的首选方法。大多数患者实现了一期闭合，并发症发生率较低。该技术简单且易于掌握。技术并发症罕见且易于修复。
