ABDOMINAL-WALL RECONSTRUCTION AFTER TEMPORARY ABDOMINAL-WALL CLOSURE IN TRAUMA PATIENTS

We retrospectively analyzed 36 patients requiring temporary abdominal wall closure on admission to a level I trauma center from 1988 to 1992 . There were 10 deaths (28%) in the study population. Of the 26 surviv ors, 8 patients (31%) had primary fascial closure at initial hospitali zation, whereas 18 patients (69%) required split-thickness skin grafti ng to visceral granulation tissue. Of these 18 patients, 13 have had v entral herniorrhaphy at subsequent admission. Eight of these patients had primary fascial closure, 4 required primary fascial approximation with prosthetic onlay reinforcement, and 1 required multiple operation s including prosthetic reconstruction and eventual complex tissue tran sfer. Complications occurred in 3 patients (14%) and included two woun d seromas, which were drained nonoperatively, and a wound infection ne cessitating removal of prosthetic material and subsequent reconstructi on with complex tissue transfer. Follow-up reveals no recurrent hernia at 24 months. Abdominal wall reconstruction after temporary closure c an be done safely and promptly, with good functional and esthetic resu lts.