Planned reoperation for trauma: a two year experience with 124 consecutive patients.

Planned reoperation is a new approach to severe truncal trauma. A review of 124 patients treated over two years was undertaken. Penetrating injuries predominated (78%) involving primarily the abdomen or abdomen and chest. An abbreviated procedure was performed when direct hemostasis was impossible (102 patients), abrupt termination was required (56 patients), or the abdomen or chest could not be closed (20 patients). The techniques employed included packing, rapid skin closure, gastrointestinal interruption, rapid vascular control, temporary urinary diversion, stapled lung resection, and plastic bag closure. Seventy-three patients survived to undergo 101 operations. The first reoperation was planned in 52 patients and unplanned (either for bleeding or for abdominal compartment syndrome) in 21 patients. There were 14 missed injuries. The overall mortality rate was 58%. Survival was significantly better when the decision to abruptly terminate the initial procedure was made early and in patients undergoing planned reoperation. Wider adoption and better definition of the indications will result in more effective use of this approach.