Delayed Closure of Ventral Abdominal Hernias After Severe Trauma
This paper was presented at the 48th Annual Meeting of the Midwest Surgical Association, August 14-17, 2005 in Ontario, Canada.
Primary closure after trauma celiotomies is not always accomplished. We reviewed our experience with delayed closure in trauma patients.
Prospective data were collected on patients who had damage-control celiotomy and were discharged with open abdomens. The time to closure, repair methods, and complication data also were compiled.
In the 6-year period, 84 patients underwent damage-control celiotomy. Thirty-one patients died and 33 patients had early closure. Twenty patients had closure during a subsequent hospitalization (mean time to delayed closure, 193 days): 8 patients (40%) had component separation, 3 (15%) had component separation with mesh, 4 (20%) had mesh alone, and primary closure occurred in 5 (25%). Nine patients (45%) had complications such as wound and mesh infections, hernias, and fistulas. Repair before or after 6 months showed no statistically significant difference for the presence of complications or enterotomies (P = .64 and .5743, respectively).
Open-abdomen reconstruction presents significant challenges. Closure within 6 months is possible; the presence of complications is not affected by early repair.