Mutafchiĭski V, Popivanov G
Khirurgiia (Sofiia). 2014(1):4-10.
Acute coagulopathy with exsanguinating bleeding occurs in 2-5% of all trauma cases carrying mortality rate near 100% after conventional management. In the last few decades, the development of damage control surgery (DCS) in combination with the technique of open abdomen led to significantly improved survival among these patients.
A descriptive study based on a retrospective analysis of 12 consecutive blast victims with exsanguinating bleeding underwent DCS and open abdomen management. All patients were soldiers injured during their deployment in Iraq and Afghanistan during 2002-2007, treated by our deployed surgical teams. Vacuum Assisted Closure (V.A.C., KCI) and vacuum pack (VP) was used for a temporary closure of abdomen. A cumulative analysis of all relevant series used these methods during the period 2000-2013 was performed.
DCS was applied in 12 of 114 consecutive blast victims (10.5%) with survival rate 66.7% (8/12). Eleven had open abdomen with temporary closure with V.A.C. in 6 and VP in 5. Four patients died before the definitive closure (36.4%). The survivors (n = 8) were with a mean age 28.5 years, suffered from a critical trauma with a mean Injury Severity Score 35.5. V.A.C was used in 4 of them, VP in 3. Primary closure of abdomen was achieved in 6 (85.7%) within 3.5 days and mean 1.3 dressing changes. Due to ACS, the abdomen was closed through skin suture only and a creation of planned ventral hernia in 1 patient treated with VP (1/7, 14.3%). Wound infection was observed in 1 case (14.3%).
Despite the small sample size, our series clearly demonstrate the benefits of DCS and open abdomen in trauma patients with exsangiunating bleeding. The survival rate is highly dependent on the rapid implementation of DCS in properly selected patients. V.A.C. and VP provide a high rate of primary fascial closure in trauma.
在所有创伤病例中，2% - 5%会出现急性凝血功能障碍并伴有大出血，经传统治疗后死亡率接近100%。在过去几十年中，损伤控制手术（DCS）与开放腹腔技术相结合，显著提高了这些患者的生存率。
一项描述性研究，基于对12例连续发生大出血的爆炸伤受害者进行回顾性分析，这些患者接受了DCS和开放腹腔治疗。所有患者均为2002 - 2007年在伊拉克和阿富汗执行任务期间受伤的士兵，由我们部署的外科团队进行治疗。采用真空辅助闭合（V.A.C.，KCI）和真空包装（VP）对腹腔进行临时闭合。对2000 - 2013年期间使用这些方法的所有相关系列进行了累积分析。
在114例连续爆炸伤受害者中，12例（10.5%）应用了DCS，生存率为66.7%（8/12）。11例患者进行了开放腹腔，其中6例采用V.A.C.临时闭合，5例采用VP临时闭合。4例患者在确定性闭合前死亡（36.4%）。幸存者（n = 8）平均年龄28.5岁，遭受严重创伤，平均损伤严重度评分为35.5。其中4例使用V.A.C.，3例使用VP。6例（85.7%）在3.5天内实现了腹腔一期闭合，平均换药1.3次。由于腹腔间隔室综合征（ACS），仅1例采用VP治疗的患者通过皮肤缝合闭合腹腔，并形成了计划性腹侧疝（1/7，14.3%）。观察到1例伤口感染（14.3%）。
尽管样本量较小，但我们的系列研究清楚地证明了DCS和开放腹腔在创伤大出血患者中的益处。生存率高度依赖于在适当选择的患者中快速实施DCS。V.A.C.和VP在创伤中提供了较高的一期筋膜闭合率。
