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Tue Apr 1 14:29:27 BST 2008

A question for the trauma.org-istas:

You've completed a brilliantly conceived and daring executed trauma laparotomy in an obese (5 ft 10 in - 250 lbs) hypotensive patient following a motor vehicle crash who required significant resuscitative efforts (1:1 transfusions with a spritzer of normal saline) and is now a bit cold 95F (35C) and you packed the liver which was mildly wet and you placed a drain over a contused by not lacerated mid portion of the pancreas. The patent is hemodynamically stable and you plan a return in 24 to 48 hours depending on his status. There are not bowel anastamoses to perform. There are not other associated injuries.

How to you do your damage control closure: specific details please - do you do anything to prevent recession of the abdominal wall - i.e., sutures approximating the edges or other measures. What is you ventilation and sedation strategy with the open, damage controlled abdomen. Please add any other thoughts you find valuable.

This is an area of much creativity (variation) and we need to share our thoughts.

Mike Sise
San Diego, CA

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