Outcomes after Temporary Abdominal Closure for Trauma Patients: Experiences from Songklanagarind Trauma Center

Abstract

Objective: Temporary abdominal closure is an acceptable method in the modern care of trauma patients but the optimal technique and strategic care remains unclear. We examine our experiences with these severly injured patients. Material and Methods: A retrospective study was made of all adult (age ≥15 years) trauma patients who experienced of temporary abdominal closure from January 2007 to December 2008 at Songklanagarind Hospital, a level I trauma center. Data were retrieved from the trauma registry and medical records. Results: Forty-three patients met the inclusion criteria. The mean age was 35 years and the average injury severity score was 29. Damage control surgery was the most common situation requiring temporary closure and usually managed with the vacuum pack technique. The average duration of an open abdomen was four days. Primary fascial closure was accomplished in 17 patients (40%). The accepted ventral hernia approach was applied in 13 patients (30%). One patient developed an enteroatmospheric fistula. Thirty patients (70%) survived until discharge. Conclusion: Most trauma patients requiring temporary abdominal closure survive and subsequent primary fascial closure is achieved in nearly half of them. Early abdominal wall closure reduces fistula formation. The major long-term morbidity is a giant ventral hernia.

Keywords

• open abdomen
• temporary abdominal closure
• trauma patients