Vacuum pack technique of temporary abdominal closure: A 7-year experience with 112 patients

Background: Temporary abdominal wound closure after celiotomy for trauma is often desirable. The ideal method of temporary closure should allow rapid closure, easy maintenance, and allow reexploration and wound repair with mi nimal tissue damage. Over the past 7 years, we have successfully used a vac uum closure system (the vacuum pack) for temporary management of the open a bdomen. Methods: Medical records of trauma patients undergoing exploratory celiotom y from April of 1992 to February of 1999 were reviewed. Demographic data as well as indications for open-abdominal management and complications of ope n-abdominal management were collected. Results: Two hundred sixteen vacuum packs were performed in 112 trauma pati ents. Of the 216 vacuum packs placed, 2.8% were placed for increased intra- abdominal. pressure, 5.3% for inability to achieve tension-free fascial clo sure, 20% for damage control, 55 % for reexploration, and 16.7% for a combi nation of factors. Sixty-two patients (55.4%) went on to primary closure an d 25 patients (22.3%) underwent polyglactin mesh repair of the defect follo wed by wound granulation and eventual skin grafting. Twenty-two patients (1 9.6%) died before abdominal closure was attempted. Five patients (4.5% ) de veloped enterocutaneous fistulae, five patients (4.5%) developed intra-abdo minal abscesses. There were no eviscerations. Three patients (2.7%) require d further explorations after abdominal closure. Overall mortality rate was 25.9%, none related to the vacuum pack. Conclusions: The vacuum pack is the temporary abdominal wound closure of ch oice in patients undergoing open abdominal management at our institution. P rimary closure is achieved in the majority of patients with a low rate of c omplication. The technique is simple and easily mastered. Technical complic ations are rare and easily repaired.