The Open Abdomen in Damage Control Surgery
The open abdomen is an integral part of the damage control surgical philosophy although it does present its own physiological penalties; it is therefore vital that as much attention is paid to the management of the open abdomen as the other aspects of DCS and the surgeon must have a full range of techniques at their command. The predominant reason for an open abdomen in DCS is to avoid the deleterious effects of raised intra-abdominal pressure such as reduced splanchnic and renal blood supply, splinting of the diaphragm with reduced tidal volume and reduced venous return.
When the abdomen is left open, the muscle fibres shorten and retract, and the viscera begin to adhere to the underside of the abdominal wall, so the key to open abdomen management is a temporary abdominal closure that minimises loss of domain and prevents adhesion formation. A variety of techniques are available, and the method chosen should reflect the local availability of equipment and skills of the surgeon. Silo methods such as the Bogota bag should only be used if nothing else is available as the techniques of choice are some sort of medial fascial traction and topical negative pressure dressings either individually or preferably in combination.
The outcomes following temporary abdominal closure are highly variable, but definitive fascial closure rates of up to 90% are achievable; complications include failure to achieve fascial closure, fistulation and subsequent incisional hernia aside from mortality which is largely attributable to the underlying traumatic injuries.
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