Successful management of the open abdomen with hydrocolloid dressing in a resource-constrained setting
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ORIGINAL ARTICLE
Successful management of the open abdomen with hydrocolloid dressing in a resource‑constrained setting O. M. Valderrama1 · A. L. Goldstein2 · S. del Carmen Monteza Gallardo1 · M. de Moya3 · M. Quiodettis1 Received: 18 May 2020 / Accepted: 17 September 2020 © Springer-Verlag France SAS, part of Springer Nature 2020
Abstract Purpose To evaluate and detail the management of a difficult, long-term, open abdomen in a resource constraint setting with the use of Hydrocolloid dressing. Method An observational retrospective study was conducted at a single level-1 trauma center. Over a 5-year period, all the open abdomen patients were evaluated and the cohorts who were treated with Hydrocolloid dressings were described in detail from their admission to their discharge. Results During this period, there were 147 open abdomens. 7.5% (11) patients required long-term open abdomen management, in which Hydrocolloid dressing was utilized. Of this group, there were no entero/colonic-atmospheric fistulas, and there was either de-novo complete skin coverage, successful skin graft placement, or definitive abdominal wall repair in all the patients. De-novo complete skin coverage took an average of 7.4 months. All the patients were discharged home after an average of 107 days hospitalized. Conclusion Despite not being an optimal management of an open abdomen, there are always a small group of these patients who lose abdominal domain, are critically ill or injured, and have prolonged hospitalization with an open abdomen. In this cohort, and especially in resource constraint settings, Hydrocolloid dressing is a cost-efficient, simple, and effective method to treat the ‘long-term’ open abdomens. Keywords Open-abdomen · Hydrocolloid dressing · Trauma · Acute care surgery
Background The utilization of an open abdomen strategy for a range of critical pathologies has become a common practice throughout the world in both rich and low-income countries [1–3]. Open abdomen may be part of a damage control approach for severe trauma, a planned second look for certain acute surgical care pathologies (such as mesenteric O. M. Valderrama and A. L. Goldstein authors contributed equally. * O. M. Valderrama [email protected] 1
Division of Trauma and Surgical Critical, Hospital Santo Tomás, Calle 37 Este, Bella Vista, Panama City, Panama
2
Division of Trauma and Acute Care Surgery, Tel Aviv Medical Center, Ichilov Hospital, Tel Aviv, Israel
3
Division of Trauma and Acute Care Surgery, Medical College of Wisconsin, Froedtert Hospital, Milwaukee, WI, USA
events), treatment for abdominal compartment syndrome, or a necessity because of severely distended bowel secondary to the systemic manifestations of the insult. Of these open abdomens, a large percentage of fascia defects are able to be eventually closed (in some reported cases 100% [4]), usually within the first few take-backs to the operating room [5]. Nevertheless, there is a group of patients who are unable to achieve complete fascia closure. If their skin is not a
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