TEMPORARY ABDOMINAL-WALL CLOSURE IN TRAUMA PATIENTS - INDICATIONS, TECHNIQUE, AND RESULTS

From 1988 to 1992 more than 5300 patients were admitted to a level I t rauma center, with 36 of these patients requiring Silastic abdominal c losure. Patients ages ranged from 13 to 75 years with a mean Injury Se verity Score (ISS) of 30 (range 13-50). Nineteen patients (53%) suffer ed penetrating injuries, and 17 (47%) were victims of blunt trauma. Si lastic closure was performed at admission laparotomy in 15 patients (4 2%) due to inability to close the fascia primarily. Twenty-one patient s (58%) underwent Silastic closure at reexploration for inability to c lose primarily (12 patients), elevated intraabdominal pressure with de teriorating renal function (6 patients), and wound sepsis with fascial necrosis (3 patients). Twenty-six patients (72%) survived and 10 pati ents (28%) expired. The causes of death were multiple organ failure (9 patients) and exsanguination (1 patient). Of the 26 survivors, 8 pati ents (31%) underwent fascial closure at initial hospitalization, and 1 8 patients (69%) required split-thickness skin grafting to visceral gr anulation tissue. Of theses 18 patients, 13 (72%) have already undergo ne ventral herniorrhaphy at subsequent admission. No patient developed a complication attributable to the technique.