Analysis of Factors Associated with Inability to Perform Delayed Primary Fascial Closure of Open Abdomen in Trauma Patients: An Institutional Based Study
European Journal of Molecular & Clinical Medicine,
2022, Volume 9, Issue 7, Pages 5960-5964
Abstract
Background: Open abdomen treatment (OAT) involves the deliberate decision not to close the fascia at the end of laparotomy. The present study was conducted to assess the factors which were associated with the inability to perform DPFC in patients with OA.Materials & Methods: A retrospective analysis of patients with OA undergoing laparotomy for trauma over the last 2 years was done. In the present study, once OA was made, patients were divided into 2 groups: Group A: Patients with OA in whom fascial closure was not possible and had to be managed with STSG/skin only closure and a planned ventral hernia at a later date and Group B: Patients with OA in whom definitive fascial closure was possible during primary admission (delayed primary fascial closure (DPFC)). Clinical and resuscitative parameters were compared in the above 2 groups. Statistical analysis was performed using the latest SPSS software.
Results: In the present study 120 patients with OA were included. After exclusion criteria were applied; only 36 patients were recruited in the study. In 8 patients, abdomen was closed on delayed primary basis, while in 28 patients, STSG/skin only closure was done and was treated as planned ventral hernia. On comparing the clinical profile of the 2 groups showed that acidosis and raised lactate levels also precluded DPFC. Hollow viscus injuries (HVIs) and associated pelvic or abdominal vascular injuries also precluded DPFC (p< 0.01), while solid organ injury was not found to be associated. While comparing the infection rates in the 2 groups, we found significantly high blood stream infections (BSIs), ventilator associated pneumonia (VAP), and intra-abdominal sepsis (IAS) in group A patients. There was a significant difference in the initial (ED +intra-operative) blood resuscitation in 2 groups
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