We read with interest the recent article by Koniaris et al1 on closure of the complex abdomen in critically ill patients. The authors describe a form of temporary abdominal coverage that incorporates multilayered dressings, a plastic sheet that protects the viscera, and dynamic horizontal retention sutures. This coverage was used in 13 patients who survived abdominal catastrophes, undergoing an average of 2.8 revisions with an 85% primary abdominal wall closure rate. Koniaris and colleagues are correct in their understanding that a tissue-impervious material that avoids contact between the viscera and the coverage area eliminates the fistula risk; their technique exemplifies low operative morbidity in patients with temporary abdominal coverage. The concept of using plastic foil to protect the viscera is not new, however. Sutureless vacuum packing and a mesh-foil combination are recent examples of complex techniques for temporary abdominal coverage that incorporate tissue-impervious materials; they have been equally successful in avoiding bowel erosion and fistulization by the overlying laparotomy coverage.2
Losanoff JE, Richman BW, Jones JW. Temporary Abdominal Coverage in Critically Ill Patients. Arch Surg. 2002;137(9):1078–1079. doi:
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