To Close or Not To Close, That Is One of the Questions? Perceptions of Trauma Association of Canada Surgical Members on the Management of the Open Abdomen
- 1 February 2006
- journal article
- Published by Wolters Kluwer Health
- Vol. 60 (2) , 287-293
- https://doi.org/10.1097/01.ta.0000203579.62446.75
Abstract
The optimal abdominal closure in critically ill surgical/trauma patients remains controversial with a wide variety of commonly employed techniques. We sought to evaluate clinical equipoise by surveying Canadian surgeons regarding the use of temporary abdominal closure strategies in damage control and emergency situations.A structured mixed-mode (Website and paper), scenario-based questionnaire was developed by members of the Canadian Trauma Trials Collaborative and directed to surgical members of the Trauma Association of Canada (TAC).The overall response rate was 84% (86 out of 102). In resuscitated hemodynamically stable trauma patients, 42% (29 out of 69) of respondents elected to primarily close an "extremely tight" abdominal cavity while only 23% (16 out of 70) would primarily close the same patient when physiologic exhaustion (Damage control (DC) conditions-hypothermia, acidosis, and coagulopathy) supervened. Although the majority reported preference for temporizing abdominal closures [73% (51 out of 70) non-DC, 75% (52 out of 69) DC] when the fascia was physically impossible to close; the reported primary use of mesh in these situations was quite high [24.6% (17 out of 69) non-DC, 24% (16 out of 69) DC], including a reported 7% (5 out of 69) nonabsorbable mesh usage in a contaminated octogenarian abdomen.Reported opinions suggest an overall appreciation for markers of "Damage Control," although clinical equipoise exists regarding the preferred technique and a frequent early use of mesh. These results highlight the necessity for further research but suggest challenges in defining a common standard for multicenter trials.Keywords
This publication has 26 references indexed in Scilit:
- Spill Your Guts! Perceptions of Trauma Association of Canada Member Surgeons Regarding the Open Abdomen and the Abdominal Compartment SyndromePublished by Wolters Kluwer Health ,2006
- Intra-abdominal Complications after Surgical Repair of Small Bowel Injuries: An International ReviewPublished by Wolters Kluwer Health ,2003
- “Components Separation Technique” for the Repair of Large Abdominal Wall HerniasJournal of the American College of Surgeons, 2003
- Penetrating Colon Injuries Requiring Resection: Diversion or Primary Anastomosis? An AAST Prospective Multicenter StudyThe Journal of Trauma: Injury, Infection, and Critical Care, 2001
- Blunt Splenic Injury in Adults: Multi-institutional Study of the Eastern Association for the Surgery of TraumaThe Journal of Trauma: Injury, Infection, and Critical Care, 2000
- “Components Separation” Method for Closure of Abdominal-Wall DefectsPlastic and Reconstructive Surgery, 1990
- The Measurement of Intra-abdominal Pressure as a Criterion for Abdominal Re-explorationAnnals of Surgery, 1984
- Elevated Intra-abdominal Pressure and Renal FunctionAnnals of Surgery, 1982
- Advances in the Management of GastroschisisAnnals of Surgery, 1980
- THE LATE COMPLICATIONS OF ABDOMINAL WAR-WOUNDSThe Lancet, 1940