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Surgery of Complex Abdominal Wall Defects pp 95–111Cite as

Reconstruction of Abdominal Wall in Trauma Patients After Damage Control

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Abstract

Reconstruction of the abdominal wall in trauma patients after damage control requires a well-thought-out management plan. In addition, there is a need for early recognition and initiation of damage control principles, optimizing resuscitation while being mindful of fluid overload, selective ventilation strategies, aggressive nutritional support, and infection management. The abdomen is initially managed with one of several temporary abdominal wall closure options. Each has advantages and disadvantages as the ideal closure method has yet to be defined. Regardless of which method is chosen, preventing loss of abdominal wall domain remains the key objective. Timing and patient selection are key factors in successful early abdominal wall closure. Aggressive diuresis after hemodynamic stabilization assists in reducing abdominal wall edema and facilitating early closure. When early closure is not possible, assessing the health of skin and fascia serves as a key step in determining management. In patients with sufficient skin, the fascia is assessed and management planned accordingly. For those with insufficient skin, we recommend considering the use of tissue expanders or complex tissue rearrangement techniques. A few select patients may require panniculectomy at time of operation to facilitate optimal closure. For patients with sufficient fascia, we recommend primary fascial closure with mesh onlay. For patients who have significant loss of abdominal domain and whose fascia is insufficient for primary closure, we recommend either component separation with subsequent primary fascial closure and mesh onlay or interpositional mesh with mesh onlay.

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References

  1. Rotondo MF, Schwab CW, McGonigal MD, et al. Damage ­control—an approach for improved survival in exsanguinating penetrating abdominal injury. J Trauma. 1993;35:375–82.

    Article  PubMed  CAS  Google Scholar 

  2. Rotonda MF, Zonies DH. The damage control sequence and underlying logic. Surg Clin North Am. 1997;77:761–77.

    Article  Google Scholar 

  3. Hirshberg A, Mattox KL. Damage control in trauma surgery. Br J Surg. 1993;80(12):1501–2.

    Article  PubMed  CAS  Google Scholar 

  4. Feliciano DV, Mattox KL, Burch JM, et al. Packing for control of hepatic hemorrhage. J Trauma. 1986;26(8):738–43.

    Article  PubMed  CAS  Google Scholar 

  5. Asensio JA, McDuffie L, Petrone P. Reliable variables in the ­exsanguinated patient which indicate damage control and predict outcome. Am J Surg. 2001;182(6):743–51.

    Article  PubMed  CAS  Google Scholar 

  6. Hirshberg A, Mattox KL. Planned reoperation for severe trauma. Ann Surg. 1995;222:3–8.

    Article  PubMed  CAS  Google Scholar 

  7. Hirshberg A, Wall Jr MJ, Ramchandani MK, et al. Reoperation for bleeding in trauma. Arch Surg. 1993;128(10):1163–7.

    Article  PubMed  CAS  Google Scholar 

  8. Moore FA et al. Incommensurate oxygen consumption in response to maximal oxygen availability predicts postinjury multiple organ failure. J Trauma. 1992;33:58–67.

    Article  PubMed  CAS  Google Scholar 

  9. Holcomb JB, Jenkins D, Rhee P, et al. Damage control resuscitation: directly addressing the early coagulopathy of trauma. J Trauma. 2007;62:307–10.

    Article  PubMed  Google Scholar 

  10. Brasel KJ, Ku J, Baker CC, Rutherford EJ. Damage control in the critically ill and injured patient. New Horiz. 1999;7:73.

    Google Scholar 

  11. Kreimeier U, Pruecker S, Peter K. Permissive hypotension. J Suisse Med. 2000;130:1516–24.

    CAS  Google Scholar 

  12. Shoemaker WC, Appel PL, Kram HB, et al. Prospective trial of supranormal values of survivors as therapeutic goal in high risk surgical patients. Chest. 1988;94:1176–86.

    Article  PubMed  CAS  Google Scholar 

  13. An G, West M. Abdominal compartment syndrome: a concise clinical review. Crit Care Med. 2008;36(4):1304–10.

    Article  PubMed  Google Scholar 

  14. Ertel W, Oberholzer A, Platz A, et al. Incidence and clinical pattern of the abdominal compartment syndrome after “damage control” laparotomy in 311 patients with severe abdominal and/or pelvic trauma. Crit Care Med. 2000;28:1747–53.

    Article  PubMed  CAS  Google Scholar 

  15. Feliciano DV, Moore EE, Mattox KL. Trauma damage control. In: Moore EE, Feliciano DV, Mattox KL, editors. Trauma. 5th ed. New York: McGraw-Hill; 2004. p. 877–99.

    Google Scholar 

  16. Ferrada P, Murthi S, Anand J, et al. Transthoracic focused rapid echocardiographic examination: real-time evaluation of fluid status in critically ill trauma patients. J Trauma. 2011;70(1):56–62; ­discussion 62–4.

    Article  PubMed  Google Scholar 

  17. Broomé A, Hansson L, Lundgren F, et al. Open treatment of abdominal septic catastrophies. World J Surg. 1983;7(6):792–6.

    Article  PubMed  Google Scholar 

  18. Shapiro MB, Jenkins DH, Schwab CW, et al. Damage control: collective review. J Trauma. 2000;49(5):969–78.

    Article  PubMed  CAS  Google Scholar 

  19. Balogh Z, McKinley BA, Holcomb JB, et al. Both primary and secondary abdominal compartment syndrome can be predicted early and are harbingers of multiple organ failure. J Trauma. 2003;54(5):848–59; discussion 859–61.

    Article  PubMed  Google Scholar 

  20. Ivatury RR, Nallathambi M, Rao PM, et al. Open management of the septic abdomen: therapeutic and prognostic considerations based on APACHE II. Crit Care Med. 1989;17(6):511–7.

    Article  PubMed  CAS  Google Scholar 

  21. Malhotra A. Low-tidal-volume ventilation in the acute respiratory distress syndrome. N Engl J Med. 2007;357(11):1113–20.

    Article  PubMed  CAS  Google Scholar 

  22. Habashi N. Other approaches to open-lung ventilation: airway pressure release ventilation. Crit Care Med. 2005;33(3):228–40.

    Article  Google Scholar 

  23. Barker DE, Kaufman HJ, Smith LA, et al. Vacuum pack technique of temporary abdominal closure: 7-year experience with 112 patients. J Trauma. 2000;48(2):201–6; discussion 206–7.

    Article  PubMed  CAS  Google Scholar 

  24. Collier B, Guillamondegui O, Cotton B, et al. Feeding the open abdomen. JPEN J Parenter Enteral Nutr. 2007;31(5):410–5.

    Article  PubMed  Google Scholar 

  25. McClave SA, Martinsdale RG, Vanek VW. Guidelines for the ­provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine and American Society for Parenteral and Enteral Nutrition. JPEN J Parenter Enteral Nutr. 2009;33(3):277–316.

    Article  PubMed  Google Scholar 

  26. Teixeira PG, Salim A, Inaba K, et al. A prospective look at the ­current state of open abdomens. Am Surg. 2008;74(10):891–7.

    PubMed  Google Scholar 

  27. Vogel TR, Diaz JJ, Miller RS, et al. The open abdomen in trauma: do infectious complications affect primary abdominal closure? Surg Infect. 2006;7(5):433–41.

    Article  Google Scholar 

  28. Dutton WD, Diaz JJ, Miller RS. Critical care issues in managing complex open abdominal wound. J Intensive Care Med. 2011;1:1–10.

    Google Scholar 

  29. Rutherford EJ, Skeete DA, Brasel KJ. Management of the patient with an open abdomen: techniques in temporary definitive closure. Curr Probl Surg. 2004;41:811–76.

    Article  Google Scholar 

  30. Bender JS, Bailey CE, Saxe JM, et al. The technique of visceral packing: recommended management of difficult fascial closure in trauma patients. J Trauma. 1994;36(2):182–5.

    Article  PubMed  CAS  Google Scholar 

  31. Fernandez L, Norwood S, Roettger R, et al. Temporary intravenous bag silo closure in severe abdominal trauma. J Trauma. 1996;40(2):258–60.

    Article  PubMed  CAS  Google Scholar 

  32. Fernandez L, Norwood S, Wilkins 3rd H, et al. Intraperitoneal silo: a form of temporary abdominal closure. Surg Rounds. 1999;22:467–78.

    Google Scholar 

  33. Allen RG, Wrenn Jr EL. Silon as a sac in the treatment of omphalocele and gastroschisis. J Pediatr Surg. 1969;4(1):3–8.

    Article  PubMed  CAS  Google Scholar 

  34. Fox VJ, Miller J, Nix AM. Temporary abdominal closure using an i.v. bag silo for severe trauma. AORN J. 1999;69(3):530–5, 537, 539–41.

    Article  PubMed  CAS  Google Scholar 

  35. Cro C, George KJ, Donnelly J, et al. Vacuum assisted closure system in the management of enterocutaneous fistulae. Postgrad Med J. 2002;78(920):364–5.

    Article  PubMed  CAS  Google Scholar 

  36. Erdmann D, Drye C, Heller L, et al. Abdominal wall defect and enterocutaneous fistula treatment with the Vacuum-Assisted Closure (V.A.C.) system. Plast Reconstr Surg. 2001;108(7):2066–8.

    Article  PubMed  CAS  Google Scholar 

  37. Stevens P. Vacuum-assisted closure of laparostomy wounds: a critical review of the literature. Int Wound J. 2009;6:259–266.

    Article  PubMed  Google Scholar 

  38. Garner GB, Ware DN, Cocanour CS, et al. Vacuum-assisted wound closure provides early fascial reapproximation in trauma patients with open abdomens. Am J Surg. 2001;182(6):630–8.

    Article  PubMed  CAS  Google Scholar 

  39. Koshima I, Soeda S. Inferior epigastric artery skin flaps without rectus abdominis muscle. Br J Plast Surg. 1989;42:645.

    Article  PubMed  CAS  Google Scholar 

  40. Sherck J, Seiver A, Shatney C, et al. Covering the “open abdomen”: a better technique. Am Surg. 1998;64(9):854–9.

    PubMed  CAS  Google Scholar 

  41. Bluebond-Langner R, Keifa ES, Mithani S, et al. Recurrent abdominal laxity following interpositional human acellular dermal matrix. Ann Plast Surg. 2008;60(1):76–80.

    Article  PubMed  CAS  Google Scholar 

  42. Scott BG, Feanny MA, Hirshberg A. Early definitive closure of the open abdomen: a quiet revolution. Scand J Surg. 2005;94:9.

    PubMed  CAS  Google Scholar 

  43. Eppley B. Experimental assessment of the revascularization of acellular human dermis for soft-tissue augmentation. Plast Reconstr Surg. 2001;107:757.

    Article  PubMed  CAS  Google Scholar 

  44. Voyles CR, Richardson JD, Bland KI, et al. Emergency abdominal wall reconstruction with polypropylene mesh: short-term benefits versus long-term complications. Ann Surg. 1981;194:219.

    Article  PubMed  CAS  Google Scholar 

  45. Puente II, Sleeman D, et al. Management of fascial dehiscence in the critically ill. Med Intensiva. 1993;17:S62.

    Google Scholar 

  46. Fabian TC, Croce MA, Pritchard F, et al. Planned ventral hernia: staged management for acute abdominal defects. Ann Surg. 1994;219:643.

    Article  PubMed  CAS  Google Scholar 

  47. Saxe JM, Ledgerwood AM, Lucas CE. Management of the difficult abdominal closure. Surg Clin North Am. 1993;73:243–51.

    PubMed  CAS  Google Scholar 

  48. Rodriguez ED, Bluebond-Langner R, Silverman RP, et al. Abdominal wall reconstruction following severe loss of domain. The R. Adams Cowley Shock Trauma Center algorithm. Plast Reconstr Surg. 2007;120:669–80.

    Article  PubMed  CAS  Google Scholar 

  49. Cothren CC, Moore EE, Johhnson JL, et al. One hundred percent fascial approximation with sequential abdominal closure of the abdomen. Am J Surg. 2006;192:238–42.

    Article  PubMed  Google Scholar 

  50. Weinberg JA, George RL, Griffin RL, et al. Closing the open abdomen: improved success with Wittman Patch staged closure. J Trauma. 2008;65:345–8.

    Article  PubMed  Google Scholar 

  51. Teichmann W, Wittmann DH, Andreone PA. Scheduled reoperations (etappenlavage) for diffuse peritonitis. Arch Surg. 1986;121(2):147–52.

    Article  PubMed  CAS  Google Scholar 

  52. Wittmann DH, Aprahamian C, Bergstein JM. Etappenlavage: advanced diffuse peritonitis managed by planned multiple ­laparotomies utilizing zippers, slide fastener, and Velcro analogue for temporary abdominal closure. World J Surg. 1990;14(2):218–26.

    Article  PubMed  CAS  Google Scholar 

  53. Wittmann DH, Aprahamian C, Bergstein JM, et al. A burr-like device to facilitate temporary abdominal closure in planned multiple laparotomies. Eur J Surg. 1993;159:75–9.

    PubMed  CAS  Google Scholar 

  54. Boele van Hensbroek PB, Wind J, Dijkgraaf MG, et al. Temporary closure of the open abdomen: a systematic review on delayed primary fascial closure in patients with an open abdomen. World J Surg. 2009;33:199–207.

    Article  PubMed  Google Scholar 

  55. Miller PR, Meredith JW, Johnson JC, et al. Prospective evaluation of vacuum-assisted fascial closure after open abdomen: planned ventral hernia rate is substantially reduced. Ann Surg. 2004;239:608–16.

    Article  PubMed  Google Scholar 

  56. Bleichrodt RP, de Vries Reilingh TS, Maylar A, et al. Component separation technique to repair large midline hernias. Oper Tech Gen Surg. 2004;6:179–88.

    Article  Google Scholar 

  57. Ramirez OM, Ruas E, Dellon AL. “Components separation” method for closure of abdominal-wall defects: an anatomic and clinical study. Plast Reconstr Surg. 1990;86:519.

    Article  PubMed  CAS  Google Scholar 

  58. Williams JK, Carlson GW, de Chalain T, et al. Role of tensor fasciae latae in abdominal wall reconstruction. Plast Reconstr Surg. 1998;101:713–8.

    Article  PubMed  CAS  Google Scholar 

  59. Sukkar SM, Dumanian GA, Szczerba SM, et al. Challenging abdominal wall defects. Am J Surg. 2001;181:115.

    Article  PubMed  CAS  Google Scholar 

  60. Luijendijk RW, Hop WC, van den Tol MP, et al. A comparison of suture repair with mesh repair for incisional hernia. N Engl J Med. 2000;343:392.

    Article  PubMed  CAS  Google Scholar 

  61. Tobias AM, Low DW. The use of subfascial Vicryl mesh buttress to aid in the closure of massive ventral hernias following damage control laparotomy. Plast Reconstr Surg. 2003;112:766.

    Article  PubMed  Google Scholar 

  62. Menon NF, Rodriguez ED, Byrnes CK, et al. Revascularization of human acellular dermis in full thickness abdominal wall reconstruction in the rabbit model. Ann Plast Surg. 2003;50:523.

    Article  PubMed  Google Scholar 

  63. Butler CE, Prieto VG. Reduction of adhesions with composite AlloDerm/polypropylene mesh implants for abdominal wall reconstruction. Plast Reconstr Surg. 2004;114:464.

    Article  PubMed  Google Scholar 

  64. Leber GE, Garb JL, Alexander AI, et al. Long-term complications associated with prosthetic repair of incisional hernias. Arch Surg. 1998;133:378.

    Article  PubMed  CAS  Google Scholar 

  65. Kron IL, Harman PK, Nolan SP. The measurement of intra-abdominal pressure as a criterion for abdominal re-exploration. Ann Surg. 1984;199(1):28–30.

    Article  PubMed  CAS  Google Scholar 

  66. Lacey SR, Bruce J, Brooks SP, et al. The relative merits of various methods of indirect measurement of intraabdominal pressure as a guide to closure of abdominal wall defects. J Pediatr Surg. 1987;22(12):1207–11.

    Article  PubMed  CAS  Google Scholar 

  67. Mayberry JC, Mullins RJ, Crass RA, et al. Prevention of abdominal compartment syndrome by absorbable mesh prosthesis closure. Arch Surg. 1997;132(9):957–61; discussion 961–2.

    Article  PubMed  CAS  Google Scholar 

  68. Saggi BH, Sugerman HJ, Ivatury RR, et al. Abdominal compartment syndrome. J Trauma. 1998;45(3):597–609.

    Article  PubMed  CAS  Google Scholar 

  69. Schein M, Wittmann DH, Aprahamian CC, et al. The abdominal compartment syndrome: the physiological and clinical consequences of elevated intra-abdominal pressure. J Am Coll Surg. 1995;180(6):745–53.

    PubMed  CAS  Google Scholar 

  70. Nagy KK, Fildes JJ, Mahr C, et al. Experience with three prosthetic materials in temporary abdominal wall closure. Am Surg. 1996;62:331.

    PubMed  CAS  Google Scholar 

  71. Scott BG, Welsh FJ, Pham HQ, et al. Early aggressive closure of the open abdomen. J Trauma. 2006;60:17.

    Article  PubMed  Google Scholar 

  72. Morris Jr JA, Eddy VA, Blinman TA, et al. The staged celiotomy for trauma. Issues in unpacking and reconstruction. Ann Surg. 1993;21(5):576–84. discussion 584–6.

    Article  Google Scholar 

  73. Silverman RP, Li EN, Holton LH, et al. Ventral hernia repair using allogenic acellular dermal matrix. Hernia. 2004;8:336.

    Article  PubMed  CAS  Google Scholar 

  74. Rohrich RJ, Lowe JB, Hackney FL, et al. An algorithm for abdominal wall reconstruction. Plast Reconstr Surg. 2000;105:202.

    Article  PubMed  CAS  Google Scholar 

  75. Fansler RF, Taheri P, Cullinane C, et al. Polypropylene mesh closure of the complicated abdominal wound. Am J Surg. 1995;170:15.

    Article  PubMed  CAS  Google Scholar 

  76. Morris-Stiff GJ, Hughes LE. The outcomes of non-absorbable mesh placed within the abdominal cavity: literature review and clinical experience. J Am Coll Surg. 1998;186:352.

    Article  PubMed  CAS  Google Scholar 

  77. Scripcariu V, Carlson G, Bancewicz J, et al. Reconstructive abdominal operations after laparostomy and multiple repeat laparotomies for severe intra-abdominal infection. Br J Surg. 1994;81(10):1475–8.

    Article  PubMed  CAS  Google Scholar 

  78. Stone HH, Fabian TC, Turkleson ML, et al. Management of acute full-thickness losses of the abdominal wall. Ann Surg. 1981;193(5):612–8.

    Article  PubMed  CAS  Google Scholar 

  79. Tyrell J, Silberman H, Chandrasoma P, et al. Absorbable versus permanent mesh in abdominal operations. Surg Gynecol Obstet. 1989;168(3):227–32.

    PubMed  CAS  Google Scholar 

  80. Jacobsen WM, Petty PM, Bite U, et al. Massive abdominal-wall hernia reconstruction with expanded external/internal oblique and transversalis musculofascia. Plast Reconstr Surg. 1997;100:326.

    Article  PubMed  CAS  Google Scholar 

  81. Bloomfield GL, Ridings PC, Blocher CR, et al. Effects of increased intra-abdominal pressure upon intracranial and cerebral perfusion pressure before and after volume expansion. J Trauma. 1996;40(6):936–41; discussion 941–3.

    Article  PubMed  CAS  Google Scholar 

  82. Hirshowitz B, Linden Baum E, Har-Shai Y. A skin-stretching device for harnessing of the visco-elastic properties of skin. Plast Reconstr Surg. 1994;92:260–70.

    Google Scholar 

  83. Maxhimer JB, Hui-Chou HG, Rodriguez ED. Clinical ­applications of the pedicled anterolateral thigh flap in complex abdominal-­pelvic reconstruction. Ann Plast Surg. 2011;66(3):285–91.

    Article  PubMed  CAS  Google Scholar 

  84. Classen D. The extended deep inferior epigastric flap: a case series. Ann Plast Surg. 1999;42:137.

    PubMed  CAS  Google Scholar 

  85. Rodriguez ED, Rosson GD, Bluebond-Langner R, et al. The utility of the anterolateral thigh donor site in reconstructing the United States trauma patient. J Trauma. 2007;62:892.

    Article  PubMed  Google Scholar 

  86. Robinson TN, Clarke JH, Walsh MD. Major mesh related complications following hernia repair: events reported to the Food and Drug Administration. Surg Endosc. 2005;19:1556.

    Article  PubMed  CAS  Google Scholar 

  87. Paul A, Korenkov M, Peters S, et al. Unacceptable results of the Mayo procedure for repair of abdominal incisional hernias. Eur J Surg. 1998;164:361.

    Article  PubMed  CAS  Google Scholar 

  88. Read RC. Repair of incisional hernia. Curr Surg. 1990;47:278.

    PubMed  CAS  Google Scholar 

  89. George CD, Ellis H. The results of incisional hernia repair: a ­twelve-year review. Ann R Coll Surg Engl. 1986;68:185.

    PubMed  CAS  Google Scholar 

  90. Mayberry JC, Goldman RK, Mullins RJ, et al. Surveyed opinion of American trauma surgeons on the prevention of the abdominal compartment syndrome. J Trauma. 1999;47:509–13.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Program in Trauma, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, 22 South Greene Street, Room P1G01, Baltimore, MD, 21201, USA

    Mayur Narayan MD, MPH, MBA & Thomas M. Scalea MD

  2. Department of Plastic, Reconstructive, and Maxillofacial Surgery, University of Maryland School of Medicine, 22 South Greene Street, Baltimore, MD, 21201, USA

    Eduardo D. Rodriguez MD, DDS

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  1. Mayur Narayan MD, MPH, MBA
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  2. Eduardo D. Rodriguez MD, DDS
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  3. Thomas M. Scalea MD
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Correspondence to Thomas M. Scalea MD .

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Editors and Affiliations

  1. Department of Surgery, University of Arizona, Tucson, 85719, Arizona, USA

    Rifat Latifi

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Narayan, M., Rodriguez, E.D., Scalea, T.M. (2013). Reconstruction of Abdominal Wall in Trauma Patients After Damage Control. In: Latifi, R. (eds) Surgery of Complex Abdominal Wall Defects. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-6354-2_13

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