Open Abdomen Treatment for Severe Trauma
Open abdomen (OA) has been proposed for more than 20 years, which is a type of surgery to save the lives of critically ill patients and also is controversial on its use since it appeared. In 2012, Chinese Medical Association issued “Diagnosis and Treatmen
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Abstract Open abdomen (OA) has been proposed for more than 20 years, which is a type of surgery to save the lives of critically ill patients and also is controversial on its use since it appeared. In 2012, Chinese Medical Association issued “Diagnosis and Treatment Norms for Trauma-induced Intra-abdominal Hypertension/Abdominal Compartment Syndrome”. In 2013, the World Association of Abdominal Compartment Syndrome (WSACS) issued new treatment guidelines and expert consensus. Based on the field progress and authors’ experience, this chapter induces the concept of open abdominal surgery, focuses on inducing key open abdomen technologies, including skin closure techniques, fascial closure techniques (FCTs) and VSD assistive technology, as well as open abdominal surgical site and incision. Also, this chapter describes perioperative management techniques at the acute stage, the middle stage and the reconstruction stage. Keywords Open abdomen
Severe trauma
The management of open abdomen (OA) for saving critically ill patients is a surgery of continuous debate since its first appearance 20 years ago. Despite the benefit, maintenance of an open abdomen creates numerous management challenges, including ① despite of decompressive laparotomy, the mortality rate of patients with abdominal compartment syndrome (ACS) is still up to 50 % [1]; ② OA may bring with potential major complications such as fluid loss, infection, fistulas, and large ventral hernias [2]; ③ patients require one or more surgeries; ④ it is named ‘nightmare’ by paramedics for high costs and long stay in hospital. On the other hand, OA can effectively reduce mortality and early postoperative morbidity, so it is one of the surgical hotspots [3]. This surgical technique has made remarkable progress since the mid-1990s and gradually becomes related to the technique of the L. Zhang (&) Trauma Center, State Key Laboratory of Trauma, Burns and Combined Injury, Daping Hospital and Research Institute of Surgery, Third Military Medical University, Chongqing, People’s Republic of China e-mail: [email protected] © Springer Nature Singapore Pte Ltd. 2017 X. Fu and L. Liu (eds.), Advanced Trauma and Surgery, DOI 10.1007/978-981-10-2425-2_2
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negative pressure wound therapy [4]. OA system equipments, such as ABThera™ has been developed. These methods can significantly remedy the shortage of the original open abdominal cavity and ensure complete definitive abdominal closure for most patients in 2–3 weeks, so that the OA surgery gradually mature. According to a review of 2012, the total number of OA cases reported was 5248 by 2011 [3]. Reasonable application of this technique will certainly improve outcomes of abdominal critically ill patients [5]. Given that IAH/ACS associated with trauma is more and more common, the traumatology branch of Chinese Medical Association has published a guideline to its diagnosis and treatment (A guideline to the diagnosis and treatment of IAH/ACS associated with trauma) in 2012 [6], hoping to effectively decrease its occurrence
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