trauma-list Digest, Vol 67, Issue 43

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Dear Dr Juan,

In query and interest of your statement:

"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. "

I am not particularly experienced in this area, but I would think bed-side
USS sufficient to rule out a subcutaneous collection if no external evidence
of wound infection/cellulitis? Do you extend this approach to other 'dirty'
procedures, emergency or otherwise?

I also humbly propose that a patient with sepsis day 5-7 post-damage control
laparotomy with enteric injury receiving a CT scan is most likely not a
VOMIT? :)

Kind regards,

Brad Morris
Surgical Registrar
Australia




On Wed, Feb 4, 2009 at 7:47 AM, tina <tinagaar at online.no> wrote:

> Tim
>
> ...you can add this part of Scandinavia to the "closing skin"
> tradition...staples or suture..
>
> Tina Gaarder
> Trauma and GI Surgery
> Head of Trauma Unit
> Oslo University Hospital, Norway
> (list lurker)
>
> -----Original Message-----
> From: trauma-list-bounces at trauma.org [mailto:
> trauma-list-bounces at trauma.org]
> On Behalf Of Dr Timothy Hardcastle
> Sent: 03 February 2009 18:46
> To: Trauma &amp; Critical Care mailing list
> Subject: RE: trauma-list Digest, Vol 67, Issue 43
>
> Mike wrote:
> > 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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> Dear Mike
>
> I close skin - as do most South African surgeons to my knowledge; the idea
> of leaving skin open is a very American thing, certainly never advocated
> in this country and to my knowledge not in the UK or Australia either.
>
> Tim
> Dr T C Hardcastle
> M.B., Ch.B. (Stell); M. Med. (Chir) (Stell); FCS (SA)
> Principal Specialist Trauma Surgeon /
> Honorary Lecturer UKZN Dept Surgery
> Deputy Director - IALCH Trauma Service
> Durban - South Africa
>
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