THE TECHNIQUE OF VISCERAL PACKING - RECOMMENDED MANAGEMENT OF DIFFICULT FASCIAL CLOSURE IN TRAUMA PATIENTS

Since 1986, we have cared for 17 patients whose abdomen could not be c losed because of bowel edema and loss of abdominal wall compliance. Th ese patients were managed by a technique of visceral packing with the intestines kept in place by a combination of rayon cloth, gauze packs, and retention sutures. This packing was changed in the operating room under general anesthesia until the edema was sufficiently resolved to allow for closure. Two patients died within 24 hours of operation fro m irreversible shock. The remaining 15 patients had their fascia succe ssfully closed with an average of two additional anesthetics. There wa s one case of fasciitis associated with the development of an intra-ab dominal abscess and one patient died of late sepsis. There was no earl y postoperative ventilatory compromise or acute oliguric renal failure . Other direct complications have been minor with no enterocutaneous f istulae, dehiscence, or incisional hernia. Visceral packing of posttra umatic abdominal wounds circumvents expected complications of intraper itoneal hypertension and enhances the chance for survival, Its ease an d low morbidity also lends itself to a wide variety of other uses.