trauma-list Digest, Vol 67, Issue 43

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Mike

I have in the past on many occasions closed the skin after damage control fascial closure without any problem and I'm an old surgeon. I also in the past have closed over a catheter and intimately irrigated and sucked with good results. Now days though if I'm the least little bit unsure I'll put a wound vac in and come back in a couple of days and close it. The one thing I don't like although I've done it in the remote past is  a "loose closure" with packing between the stitches.

R. Wigle MD FACS



----- Original Message ----
From: jduchesne1 <jduchesn at tulane.edu>
To: Trauma & <trauma-list at trauma.org>
Sent: Tuesday, February 3, 2009 9:31:31 AM
Subject: Re: trauma-list Digest, Vol 67, Issue 43

Mike- Good to hear from you.
I try my best here at Charity not to close skin in the presence of any enteric injury in damage control patients. I personally leave the wound open with delay closure prior to discharge. My rationale is the following: by post-trauma day 5-7 when the patient start spiking fever then u have too many variables to rule out the source of sepsis, which will increase the need for unnecessary CT scans and VOMIT's. Keep it simple :)
Juan
CharityOne-NO
Sent via BlackBerry by AT&T

-----Original Message-----
From: "Sise, Mike MD" <Sise.Mike at scrippshealth.org>

Date: Mon, 2 Feb 2009 22:39:54 
To: <trauma-list at trauma.org>
Subject: RE: trauma-list Digest, Vol 67, Issue 43


To all trauma-listers, a question from one of my partners:  
  
You have a damage control closure with a vac closure after a laparotomy for trauma without bowel injury (ie just spleen or liver, mesentery, whatever) - you take back in 24 to 48 hours and are able to close the fascia.  What do you do with the skin?  Leave open or staple closed?  
  
We're having a debate over this in our group. Older surgeons pack skin and subQ open, younger surgeons frequently close skin. 
  
Mike Sise 
San Diego


----------------

From: trauma-list-bounces at trauma.org on behalf of trauma-list-request at trauma.org
Sent: Tue 1/27/2009 12:35 AM
To: trauma-list at trauma.org
Subject: trauma-list Digest, Vol 67, Issue 43



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