Objective: Temporary abdominal closure following damage control laparotomy (DCL) may be achieved by a variety of techniques, with wide reported ranges of success and timing in fascial closure. We sought to assess the effect of initial closure method on the ability to gain fascial closure and timing of closure.
Methods: A retrospective analysis of all trauma patients undergoing DCL upon admission to an ACS verified level one trauma center from 2011-2016 was performed. The medical record was used to identify demographic and clinical data, including closure method following DCL, number and timing of operations, injury patterns, and definitive fascial closure. Analysis included one way ANOVA, Kaplan-Meier, and multivariate logistic regression.
Results: 239 trauma patients met criteria for inclusion following DCL. Closure techniques included skin only (SO), Abthera VAC system (AV), Bogota bag (BB), or standard VAC system (VAC). Overall mean ISS 25.7±13.8 was similar between all groups. Patients closed by BB had signficantly higher initial mean lactate (7.3±5.3 mMol/L, p=0.001*) and mean 24 hour red blood cell transfusion requirements (15.5 units RBC, p=0.001*). Fascial closure was achieved in 221 patients. Initial BB closure was significant for failure to obtain fascial closure (OR 5.80; 95% CI, 1.05-32.04) and increased mortality (OR 3.25; 95% CI, 1.16-9.11). Average closure time was longest with BB (5.70±5.59 days).
Conclusions: Use of BB for temporary abdominal closure in the setting of trauma is associated with significantly increased time to fascial closure, inability to gain fascial closure, and increased hospital mortality.
