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Invited Critique
December 2001

Dynamic Retention: A Technique for Closure of the Complex Abdomen in Critically Ill Patients—Invited Critique

Arch Surg. 2001;136(12):1363. doi:10.1001/archsurg.136.12.1363

The surgical modus operandi calls for routine closure of the abdomen. Many surgeons have closed the abdomen under tension, thinking the subsequent development of renal shutdown, respiratory failure, and/or necrotizing fasciitis is unrelated. Koniaris and colleagues present a select patient subset in whom innovative techniques must be applied. Their dynamic-retention suture technique mirrors a procedure used by Dr Ledgerwood and myself1 and our progeny for more than 30 years: the inner layer of bowel bag (vs army surplus parachute silk) and a second layer of burn dressing (vs fluffs) are secured by extraperitoneally placed large, nonabsorbable sutures. Additional exterior dressings and drainage catheters help contain extensive peritoneal fluid that continually drains. The authors highlight many complications with other techniques, namely, bowel fistulae with mesh, refractory infection and abscess with nonabsorbable mesh and Gore-Tex bridging grafts, wound disruption with absorbable mesh, and the need for later abdominal wall reconstruction when skin grafts are applied to the granulation tissue covering the intestines. Based on an extensive experience with the abdominal wall pack technique, the following precautions are presented herein1,2:

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