Reconstruction of abdominal wall in trauma patients after damage control

Mayur Narayan, Eduardo D. Rodriguez, Thomas M. Scalea

Research output: Chapter in Book/Report/Conference proceedingChapter

Abstract

Reconstruction of the abdominal wall in trauma patients after damage control requires a well-thought-out management plan. In addition, there is a need for early recognition and initiation of damage control principles, optimizing resuscitation while being mindful of fluid overload, selective ventilation strategies, aggressive nutritional support, and infection management. The abdomen is initially managed with one of several temporary abdominal wall closure options. Each has advantages and disadvantages as the ideal closure method has yet to be defined. Regardless of which method is chosen, preventing loss of abdominal wall domain remains the key objective. Timing and patient selection are key factors in successful early abdominal wall closure. Aggressive diuresis after hemodynamic stabilization assists in reducing abdominal wall edema and facilitating early closure. When early closure is not possible, assessing the health of skin and fascia serves as a key step in determining management. In patients with sufficient skin, the fascia is assessed and management planned accordingly. For those with insufficient skin, we recommend considering the use of tissue expanders or complex tissue rearrangement techniques. A few select patients may require panniculectomy at time of operation to facilitate optimal closure. For patients with sufficient fascia, we recommend primary fascial closure with mesh onlay. For patients who have significant loss of abdominal domain and whose fascia is insufficient for primary closure, we recommend either component separation with subsequent primary fascial closure and mesh onlay or interpositional mesh with mesh onlay.

Original languageEnglish (US)
Title of host publicationSurgery of Complex Abdominal Wall Defects
PublisherSpringer New York
Pages95-111
Number of pages17
ISBN (Electronic)9781461463542
ISBN (Print)9781461463535
DOIs
StatePublished - Jan 1 2013

Keywords

  • Complex tissue rearrangement
  • Component separation
  • Damage control
  • Definitive complex open abdominal wall reconstruction
  • Free flaps
  • Infection management
  • Laparotomy
  • Local pedicle
  • Mesh only
  • Nutrition
  • Temporary abdominal wall closure
  • Tissue expanders
  • Ventilation

ASJC Scopus subject areas

  • Medicine(all)

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  • Cite this

    Narayan, M., Rodriguez, E. D., & Scalea, T. M. (2013). Reconstruction of abdominal wall in trauma patients after damage control. In Surgery of Complex Abdominal Wall Defects (pp. 95-111). Springer New York. https://doi.org/10.1007/978-1-4614-6354-2_13