2011 Volume 31 Issue 5 Pages 777-781
Several methods of temporary abdominal closure (TAC), utilizing various materials, are employed during damage control surgery. We describe a case of TAC using a silo closure method that adopted a wound retractor (Applied AlexisTM). A 17-year-old man who was injured in a motorcycle traffic accident was brought to our hospital in an ambulance. He suffered from compound multiple pelvic fractures with broad genital laceration. He developed hemorrhagic shock due to massive bleeding from the laceration, so pelvic gauze packing was used to achieve hemostasis during laparotomy. Hemostasis was attained after the packing, but because of his serious injury, we determined that a planned reoperation was required. With the aim of accomplishing the TAC procedure, an extra-wound ring of Applied AlexisTM was applied and rotated to keep the peritoneal cavity airtight, and was then covered over with a sterilized drape. On the fourth day after the pelvic gauze packing, the gauze was removed, a sigmoid-colostomy was performed, and then the abdominal wall was closed. We successfully released the patient from the TAC and were able to do the second laparotomy rapidly and easily. No surgical site infection developed during the perioperative period. We suggest this unique technique preserves the viscera from physical injury and surgical site infection, and also reduces abdominal compartment syndrome, as well as enabling spontaneous silo closure for gastroschisis.
