Early Closure of Fascia for Open Abdominal Wounds Is Imperative

Striving to achieve definitive closure of open abdominal wounds in the battlefield has resulted in a decreasing rate of complications, according to a new study.

Researchers at Walter Reed Army Medical Center (Washington, DC, USA) reviewed data on 83 soldiers evacuated to the hospital for management of open abdominal wounds sustained in military operations in Iraq. The wounds were the result of secondary blast in 47 cases, gunshot in 29 cases, and blunt trauma in 7 cases. Initial surgical management of the soldiers in the field included early definitive closure in 56 cases (67%), primary fascial closure in 15 cases (18%), planned ventral hernia in 9 cases (11%), and vacuum-assisted closure with in 3 cases.

The study results showed that morbidity was lowest (60%) in primary repair patients. Early definitive closure involved serial closure with Gore-Tex (Newark, DE, USA) Dualmesh and final closure with polypropylene mesh in 62% of cases, or Lifecell (Branchburg, NJ, USA) AlloDerm in 31% of cases. The fistula rate was highest (20%) among patients with planned ventral hernias and 2 of the 15 patients with planned ventral hernia died. However, the rate of mesh and planned ventral hernia complications decreased over the last two years of the study. Complications included removal of infected prosthetic mesh in four patients who underwent early definitive closure. The study was published in the December 2008 issue of the Journal of the American College of Surgeons.

"Primary closure of fascia is ideal but not always possible,” said lead author Amy Vertrees, M.D. "Use of biologic mesh as either final early definitive closure or with vacuum-assisted closure also requires long-term follow-up to justify its increased cost and increased risk of abdominal wall laxity.”

The researchers recommended avoidance of planned ventral hernia and use of early definitive closure to minimize formation of fistulae.

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Walter Reed Army Medical Center
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