Cook County Trauma Unit, JSH Cook County Hospital, Chicago, Illinois 60612, USA.
J Trauma Acute Care Surg. 2013 Jun;74(6):1486-92. doi: 10.1097/TA.0b013e3182924950.
Damage-control laparotomy (DCL) has revolutionized the surgery of injury. However, this has led to the dilemma of the nonclosable abdomen. Subsequently, there exists a subgroup of patients who after resuscitation and diuresis, remain nonclosable. Before the adoption of our open abdomen protocol (OAP) and use of transabdominal wall traction (TAWT), these patients required skin grafting and a planned ventral hernia. We hypothesize that our OAP and TAWT device, which use full abdominal wall thickness sutures to dynamically distribute midline traction, achieve an improved method of fascial reapproximation.
From 2008 to 2011, all DCL and decompressive laparotomy patients in our urban trauma center were managed by our OAP. Thirty two were noncloseable "domain loss abdomens" after achieving physiologic steady state and near dry weight. All patients received the TAWT device when near dry weight was achieved. Wound size, days to closure, days to TAWT, and TAWT to closure were tracked.
During this 36-month period, OAP/TAWT was applied to 32 patients. All patients demonstrated domain loss precluding fascial closure. Average wound size was 18.5-cm width by 30.5-cm length. Mean time DCL surgery to TAWT was 9.5 days. At time of placement, TAWT decreased initial wound width by an average of 9.8 cm (51.4%). Patients returned to the operating room for tightening/washout an average of 2.2 times (excluding TAWT insertion and final closure operations). Mean time TAWT to closure was 8.7 days. Mean time from admission surgery to primary closure was 18.2 days. All patients achieved primary fascial closure using this method without components separation or biologic bridge operations.
OAP/TAWT has revolutionized the way we manage "domain loss" open abdomen patients and has virtually eliminated the acceptance of planned ventral hernia. TAWT consistently recaptures lost domain, preserves the leading fascial edge, and eliminates the need for biologic bridges, components separation, or skin grafting.
Therapeutic study, level III.
损伤控制性剖腹术（DCL）彻底改变了创伤手术。然而，这导致了无法关闭腹部的困境。随后，存在一部分患者在复苏和利尿后仍然无法关闭腹部。在采用我们的开放腹部协议（OAP）和使用经腹壁牵引（TAWT）之前，这些患者需要植皮和计划行腹侧疝修补术。我们假设，我们的 OAP 和 TAWT 装置使用全腹壁厚度缝线来动态分配中线牵引，实现了一种改进的筋膜接近方法。
从 2008 年到 2011 年，我们城市创伤中心的所有 DCL 和减压剖腹术患者均采用我们的 OAP 进行治疗。在达到生理稳定状态和接近干体重后，有 32 例患者的“区域丢失腹部”无法关闭。所有患者在接近干体重时都接受了 TAWT 装置。跟踪了伤口大小、关闭时间、TAWT 时间和 TAWT 至关闭时间。
在这 36 个月期间，OAP/TAWT 应用于 32 例患者。所有患者均表现出区域丢失，无法进行筋膜关闭。平均伤口大小为 18.5 厘米宽×30.5 厘米长。DCL 手术至 TAWT 的平均时间为 9.5 天。在放置 TAWT 时，初始伤口宽度平均减少了 9.8 厘米（51.4%）。患者平均返回手术室进行收紧/冲洗 2.2 次（不包括 TAWT 插入和最终关闭手术）。TAWT 至关闭的平均时间为 8.7 天。从入院手术到初次关闭的平均时间为 18.2 天。所有患者均采用这种方法实现了初次筋膜关闭，而无需进行组件分离或生物桥手术。
OAP/TAWT 彻底改变了我们管理“区域丢失”开放腹部患者的方式，几乎消除了对计划行腹侧疝的接受。TAWT 始终可以重新获得丢失的区域，保持主导筋膜边缘，并消除对生物桥、组件分离或植皮的需求。
治疗研究，III 级。
