Management of the patient with an open abdomen: Techniques in temporary and definitive closure

Abstract

Although the commitment of resources and manpower to the care of these patients is significant, the improvement in outcome justifies the cost. The potential to develop the triangle of death must be anticipated and expeditious closure of body cavities pursued. The ideal temporary closure has yet to be developed, but Dexon mesh, followed by skin grafting and late components separation, has demonstrated satisfactory results. Whether use of the Bogotá bag and vacuum assisted closure will eliminate late fascial complications is unknown but early results are promising. Any of the techniques described under definitive closure could also be used as a temporary closure. Expense and ultimate removal make the definitive materials a poor choice for temporary closure. Patients surviving "damage control" can and do return to activities of daily living and gainful employment. Abdominal wall reconstruction also restores their physical and mental health to that of the U.S. general population as measured by the SF-36 Health Survey.195 "Victory belongs to the most persevering" (Napoleon).