TEMPORARY ABDOMINAL-WALL CLOSURE IN TRAUMA PATIENTS - INDICATIONS, TECHNIQUE, AND RESULTS

From 1988 to 1992 more than 5300 patients were admitted to a level I trauma center, with 36 of these patients requiring Silastic abdominal closure. Patients ages ranged from 13 to 75 years with a mean Injury Severity Score (ISS) of 30 (range 13-50). Nineteen patients (53%) suffered penetrating injuries, and 17 (47%) were victims of blunt trauma. Silastic closure was performed at admission laparotomy in 15 patients (42%) due to inability to close the fascia primarily. Twenty-one patients (58%) underwent Silastic closure at reexploration for inability to close primarily (12 patients), elevated intraabdominal pressure with deteriorating renal function (6 patients), and wound sepsis with fascial necrosis (3 patients). Twenty-six patients (72%) survived and 10 patients (28%) expired. The causes of death were multiple organ failure (9 patients) and exsanguination (1 patient). Of the 26 survivors, 8 patients (31%) underwent fascial closure at initial hospitalization, and 18 patients (69%) required split-thickness skin grafting to visceral granulation tissue. Of theses 18 patients, 13 (72%) have already undergone ventral herniorrhaphy at subsequent admission. No patient developed a complication attributable to the technique.