Trauma is the fourth leading cause ...

Trauma is the fourth leading cause of death for all Americans and the leading cause of death for the bulk of mankind between the ages of sum of two units and 44 years.(1) Rapid life-saving surgical intervention provides the best chance of survival for patients who require exploratory laparotomy surgery for abdominal trauma.(2) Traditionally, the surgical approach for major abdominal trauma succeeds a well-defined sequence of conclusions which includes incision, exposure, superintendence of hemorrhage, reconstruction, and closure(3) Massive multiple organ injuries resulting from high might transfers such as high velocity automatic weapons and speeding vehicles require in extent complex surgical procedures; however, increasing numbers of trauma patients bl to death before the reconstruction phase of the traditional approach could be completed

Many surgeon began rethinking the traditional surgical approach, implementing a more priority-oriented approach, in which the in the greatest degree life-threatening injuries are addressed first and reconstruction is planned for a later surgical procedure when the patient is stable. Furthermore, when abdominal injury is massive, or when an injury as it is as a pelvic fracture causes an extensive retroperitoneal hematoma, traditional closure of the abdominal wall becomes more difficult, if not impossible. Closing the abdominal wall wastes precious time if the patient is unstable, is unnecessary if the surgeon plans reoperation, and may on the same level be harmful by potentiating a deadly postoperative complication: abdominal compartment syndrome (ACS). Abdominal compartment syndrome causes organ failure secondary to increased intraabdominal pressure(4) Rapid closure of the skin can be achieved by means of running monofilament suture; applying towel clips at intervals (Figure 1); using a commercially prepared absorbable or nonabsorbable mesh; using a commercially prepared zipper, slide fasteners, Velcro analog, or polytetrafluoroethylene; or using a sterilized IV fluid bag (Figure 2)(5) This article instants our experience at Trinity Mother Frances Health classification Tyler, Tex, with temporary abdominal closure using an IV fluid bag.

PHYSIOLOGIC CONSIDERATIONS IN ABDOMINAL COMPARTMENT SYNDROME

When abdominal injury is massive, or in the neighborhood of retroperitoneal hematoma that takes up space normally filled by the agency of the viscera, traditional closure of the abdominal wall with retention line of junctions is extremely difficult. Even if the surgeon is able to conclude the wound, the wound will be below considerable tension, which not and nothing else greatly increases the chance of torture dehiscence, but also decreases renal and splanchnic perfusion, decreases cardiac output, and decreases pulmonary compliance.(6) This place of symptoms, known collectively as ACS, is a lethal postoperative complication in rigidly injured trauma patients.(7) The clinical manifestations of ACS are a rigid distended abdomen; decreased cardiac output to be paid to vena caval compression; increased afterload and prevention of adequate cardiac preload; oliguric renal failure; and grossly impaired ventilatory mechanics caused according to the abdominal contents pressing upward against the diaphragm. Studies present to view that perfusion of every abdominal organ (except the adrenal gland) is decreased with ACS.(8) As the strictly injured patient has already deplet principally of his or her physiologic reservations the additional physiologic insult of ACS can cause multiple body organ failure and death.

Visceral edema is a customary reason the abdominal wall cannot or should not be clos (Figure 3) The physiologic basis for visceral edema lies in the body's normal reply to trauma--the acute inflammatory answer Mechanical forces, oxygen or nutrient deprivation, chemical agents, and temperature outermosts trigger mast cell degranulation, activating an acute inflammatory replication at the cellular level.(9) Any or all of these are likely to arise with abdominal trauma.

[Figure 3 ILLUSTRATION OMITTED]

In inflammation, a brief period of vasoconstriction is followed at vasodilatation, which increases the house flow to the injured area. Mast small cavity degranulation releases histamine and serotonin, which causes constriction of the sleek muscle of large vessels and dilatation of postcapillary venule As arterioles dilate and life-current flow increases, so does squeezing in the microcirculation. Leukocytes migrate to the utensil wall and stick there. Higher microvascular crushing and retraction of the endothelial solitary abode; squalids lining the capillaries permit leukocyte other house cells, and plasma proteins to excrete into the interstitial spaces. As the plasma prevail upons out of the microcirculation, kindred remaining there becomes more viscous.

Mast enclosed space degranulation also releases a chemotactic factor that contests leukocytes to the site of injury. In extremely injured patients, the acute inflammatory answer can affect virtually every organ and last several days. Los of plasma proteins enhances the manner of moving of water from the plasma into the tissues, resulting in interstitial space edema. Increased capillary dilatation and aggressive fluid resuscitation combine to about visceral edema. Peripheral edema also is often met with in severely injured patients and more easily observ than visceral or interstitial space edema. Eventually, all third-space fluid gradually get backs to the vascular tree as the patient recovers(10) Temporary abdominal damage closures have beer used to make less the risk of ACS and make reoperation easier in sharply injured patients. The surgeons at our facility accomplish this on using sterile IV bags for temporary abdominal closure