Abstract
A 29-year-old constructive worker fell onto a steel column and suffered an impalement injury to the perineal region. We performed urgent laparotomy for a hemorrhagic shock state. Laparotomy encountered massive bleeding from zone 3 of the peritoneum. Hemostasis was accomplished with gauze-packing. The abdominal wall remained open with handmade vacuum pack closure (VAC). During the open abdomen and damage control (OA/DC) strategy, prolonged edema of the bowel and small intestinal fistula made it impossible to close the abdomen primarily. On hospital day 19, we placed an orthopedic external fixation device at the open abdominal wall and approached with it by about 2 cm day by day. We successfully closed the abdomen after 8 days. An orthopedic external fixator was effective for the secondary abdominal fascial closure.
