BACKGROUND: The advances in patient care with trauma or severe intra-abdominal infections, brought important gains in survival with the use of peritoneostomies. But the management of patients brought a difficult problem: the primary closure without tension of the abdominal cavity. AIM: To present a proposal for temporary coverage of peritoneostomies in patients undergoing damage control laparotomy or decompressive laparotomy for abdominal compartment syndrome. TECHNIC: Isolation of the small intestine loops from abdominal internal; coverage of the intestinal surface with a polyethylene film multiperforated with sterile scissors or scalpel blade, to prevent direct contact with the foam. It is placed below the edges of the defect between the parietal and visceral peritoneum. Over it, a polyurethane sterile foam is fixed to the edges, leaving the defect tension free to the vacuum be applied. Another coverage with a plastic adhesive polyester impregnated with iodine stuck to skin is done, and, at the end, is added a drainage continuous aspiration system. The dressing is changed between three and five days. It was used successfully in four patients with primary closure of the abdominal cavity after seven to 21 days. Of these, three had open abdomen after laparotomy for trauma (two due to damage control and one for lack of primary closure); the fourth had been previously submitted to decompressive laparotomy for abdominal compartment syndrome. CONCLUSION: The vacuum dressing proved to be good choice for temporary coverage of peritoneostomies allowing faster closure of the abdominal wound, reducing the number of reoperations and providing protection against bacterial contamination of the intestinal loops.
BACKGROUND: The advances in patient care with trauma or severe intra-abdominal infections, brought important gains in survival with the use of peritoneostomies. But the management of patients brought a difficult problem: the primary closure without tension of the abdominal cavity. AIM: To present a proposal for temporary coverage of peritoneostomies in patients undergoing damage control laparotomy or decompressive laparotomy for abdominal compartment syndrome. TECHNIC: Isolation of the small intestine loops from abdominal internal; coverage of the intestinal surface with a polyethylene film multiperforated with sterile scissors or scalpel blade, to prevent direct contact with the foam. It is placed below the edges of the defect between the parietal and visceral peritoneum. Over it, a polyurethane sterile foam is fixed to the edges, leaving the defect tension free to the vacuum be applied. Another coverage with a plastic adhesive polyester impregnated with iodine stuck to skin is done, and, at the end, is added a drainage continuous aspiration system. The dressing is changed between three and five days. It was used successfully in four patients with primary closure of the abdominal cavity after seven to 21 days. Of these, three had open abdomen after laparotomy for trauma (two due to damage control and one for lack of primary closure); the fourth had been previously submitted to decompressive laparotomy for abdominal compartment syndrome. CONCLUSION: The vacuum dressing proved to be good choice for temporary coverage of peritoneostomies allowing faster closure of the abdominal wound, reducing the number of reoperations and providing protection against bacterial contamination of the intestinal loops.