Management of Open Abdomen After Trauma Laparotomy: Experience at a Level 1 Trauma Center in Thailand




Background: Open abdomen occurs most often after damage-control surgery following trauma. This condition is a temporary abdominal closure of the abdominal cavity which is left open. Objectives: This study aims to describe the experience and management in open abdomen trauma patients at a level 1 trauma center in Thailand. Patients and Methods: A retrospective review was performed of all adult trauma patients who had open abdomen after laparotomy between January 2011 and December 2012. Patients who had open abdomen but did not survive in the operating room were excluded. The data were collected from the trauma registry and medical records. Results: After 157 trauma laparotomies, 35 (22%) were open abdomen cases with an average injury severity score was 35. Ninety-four percent of open abdomens occurred after damage-control surgery. Temporary vacuum-assisted closure was applied in all patients. The fascial closure rate was 40%. In patients who failed to achieve a standard fascial closure, the skin closure technique alone was used. Deep surgical site infection was the most common complication after the abdominal cavities were closed. No enterocutaneous fistulae were reported. Conclusions: Vacuum-assisted abdominal closure is a good technique for temporary abdominal closure. In patients who are unable to achieve fascial closure, skin closure alone is safe.