China
Africa
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Torso trauma
Published in Ian Greaves, Military Medicine in Iraq and Afghanistan, 2018
Topical negative pressure dressings58 (V.A.C. Via™ and ABThera™) have been successfully utilised in the management of low exudate (V.A.C. Via™) or high exudate open abdominal wounds (ABThera™).59 The Wittmann Patch is an artificial dressing that serves as a temporary abdominal fascial prosthesis in cases where the abdomen cannot be closed due to abdominal compartment syndrome or because multiple further operations are planned (staged abdominal repair). It consists of a sterile hook and a sterile loop sheet made from propylene.
Damage Control
Published in Kenneth D Boffard, Manual of Definitive Surgical Trauma Care: Incorporating Definitive Anaesthetic Trauma Care, 2019
If delayed primary closure is not possible after several days or a week, there are several options: Closure of skin only, allowing the formation of a hernia.Biological material such as human (AlloDerm) or porcine (Permacol) dermal matrix used as mesh early to prevent hernia formation, providing skin coverage.Continued vacuum-assisted temporary abdominal closure such as V.A.C.® (Kinetic Concepts Inc., KCI. San Antonio, TX, USA) and Renasys® (Smith and Nephew, London, UK) until granulation over bowel occurs, for subsequent split-thickness skin grafting.If a synthetic mesh is left in situ, skin coverage of the resulting defect by split-grafting or flap transfer – never use a polypropylene only mesh.For large hernias, often the need for later reconstruction using different techniques such as component separation and flap construction.A Wittmann patch.A multitude of tension assist devices that are now available.
A Novel Method of Damage Control for Multiple Discontinuous Intestinal Injuries with Hemorrhagic Shock: A Controlled Experiment
Published in Journal of Investigative Surgery, 2020
Weihang Wu, Zhicong Cai, Nan Lin, Weijin Yang, Jie Hong, Li Lin, Zhixiong Lin, Junchuan Song, Yongchao Fang, Chen Lin, Hongwen Zhang, Dongsheng Chen, Yu Wang
Open abdomen procedures may cause derangement of fluid and electrolyte balance, systemic inflammatory response, gastrointestinal fistula, adhesions, infection, intra-abdominal abscesses and so on [22]. The general methods of temporary abdominal closure, which are towel forceps, bogota bag, mesh clamp, Wittmann patch and so on [23], may cause skin injury, abdominal infection, hernia, intestinal fistula, abdominal retraction, and other related complications [23, 24]. In this study, temporary abdominal closure was performed with the self-made TCC. Our experimental results showed that TCC was a safe and reliable method for temporary abdominal closure, and slipping of the TCC was not observed either. We successfully applied the TCC to clinical gastrointestinal surgery. Visibility was its main advantage, as changes in the bowel can be easily observed through the TCC so that the extremely necrotic intestines could be removed if necessary. This experiment was an observational study aiming to compare the efficiency of two methods for the treatment of intestinal injury. So when we found that intestines became necrotic, we dealt with them until definitive surgery. We believe that in the future, timely diagnosis of intestinal necrosis will prove to be a significant advantage.