Stathis Poulakidas1, Areta Kowal-Vern. 1. Department of Trauma, Sumner L. Koch Burn Center, John H. Stroger, Jr. Hospital of Cook County, Chicago, Illinois 60612, USA. spoulakdoc1@msn.com
Abstract
BACKGROUND: Component separation technique has been used successfully in ventral hernia repair occurring after damage control surgery. Abdominal compartment syndrome, seen in severely injured burn patients, frequently requires decompressive laparotomy. The patient is at risk during this time not only for burn injury complications but also for those from an open abdomen. METHODS: This report presents the successful application of the component separation technique for early closure of decompressive laparotomies in patients with >75% total body surface area burn, which included the abdominal wall. RESULTS: Skin flaps (necrotic/burned skin) overlying the abdominal wall fascia were raised bilaterally at the costal margin, from the anterior superior iliac spine inferiorly to the ribs superiorly. An incision was made just lateral to the rectus sheath through the aponeurosis of the external oblique muscle. With this, the fascia was mobilized to the middle with no tension. With no elevation of the patient's intrathoracic pressure on closure of the abdomen, multiple no. 2 Ethibond fascial figure of eight sutures closed the abdomen. Skin flaps were excised, so that grafting of the abdominal wall could occur. CONCLUSION: Burn patients, who required decompressive laparotomies for abdominal compartment syndrome in response to massive fluid resuscitation, tolerated early closure by the modified component separation technique. This markedly improved the care of these critically burned individuals, allowing for less third space fluid loss, less difficulty in management of the open abdominal wound, along with decreased risk of potential enterocutaneous fistula and intraabdominal abscess formation.
BACKGROUND: Component separation technique has been used successfully in ventral hernia repair occurring after damage control surgery. Abdominal compartment syndrome, seen in severely injured burn patients, frequently requires decompressive laparotomy. The patient is at risk during this time not only for burn injury complications but also for those from an open abdomen. METHODS: This report presents the successful application of the component separation technique for early closure of decompressive laparotomies in patients with >75% total body surface area burn, which included the abdominal wall. RESULTS:Skin flaps (necrotic/burned skin) overlying the abdominal wall fascia were raised bilaterally at the costal margin, from the anterior superior iliac spine inferiorly to the ribs superiorly. An incision was made just lateral to the rectus sheath through the aponeurosis of the external oblique muscle. With this, the fascia was mobilized to the middle with no tension. With no elevation of the patient's intrathoracic pressure on closure of the abdomen, multiple no. 2 Ethibond fascial figure of eight sutures closed the abdomen. Skin flaps were excised, so that grafting of the abdominal wall could occur. CONCLUSION: Burn patients, who required decompressive laparotomies for abdominal compartment syndrome in response to massive fluid resuscitation, tolerated early closure by the modified component separation technique. This markedly improved the care of these critically burned individuals, allowing for less third space fluid loss, less difficulty in management of the open abdominal wound, along with decreased risk of potential enterocutaneous fistula and intraabdominal abscess formation.