eMedicine Specialties > General Surgery > Abdomen

Temporary Abdominal Closure Techniques: Multimedia

Author: Luis G Fernandez, MD, FACS, FASAS, FCCP, FCCM, FICS, Assistant Clinical Professor of Surgery and Family Practice, University of Texas Health Science Center; Chairman, Division of Trauma Surgery and Surgical Critical Care, Chief of Critical Care Units, Trinity Mother Francis Health System
Contributor Information and Disclosures

Updated: Aug 12, 2008

Multimedia

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Media file 1: Damage-control celiotomy in progress.

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Damage-control celiotomy in progress.

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Media file 2: Edematous eviscerated bowel in a patient with blunt trauma.

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Edematous eviscerated bowel in a patient with blunt trauma.

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Media file 3: Close-up view of edematous bowel.

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Close-up view of edematous bowel.

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Media file 4: Grading abdominal pressure. Courtesy of Saggi BH, Sugerman HJ, Ivatury RR, et al. Abdominal compartment syndrome. J Trauma 1998; 45: 597-609.

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Grading abdominal pressure. Courtesy of Saggi BH, Sugerman HJ, Ivatury RR, et al. Abdominal compartment syndrome. J Trauma 1998; 45: 597-609.

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Media file 5: Left lateral thoracotomy with towel clip closure of damage-control celiotomy. Courtesy of Pedro Gustavo R. Teixeira, Trauma Surgeon, Brazil, The Trauma Imagebank.

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Left lateral thoracotomy with towel clip closure of damage-control celiotomy. Courtesy of Pedro Gustavo R. Teixeira, Trauma Surgeon, Brazil, The Trauma Imagebank.

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Media file 6: Evisceration of the bowel (as illustrated) may occur if towel clips are not placed properly (1 cm from skin edge X 1 cm apart). This temporizing measure may not decompress the abdomen adequately. Intra-abdominal pressures as high as 50 mm Hg have been obtained with this type of closure technique.

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Evisceration of the bowel (as illustrated) may occur if towel clips are not placed properly (1 cm from skin edge X 1 cm apart). This temporizing measure may not decompress the abdomen adequately. Intra-abdominal pressures as high as 50 mm Hg have been obtained with this type of closure technique.

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Media file 7: Either a conventional zipper or a commercial zipper is sewn to the skin or fascia with a continuous suture of 0 or 2-0 nylon or polypropylene. By using the skin, the fascia is spared and the incidence of postoperative fascial dehiscence may be diminished.

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Either a conventional zipper or a commercial zipper is sewn to the skin or fascia with a continuous suture of 0 or 2-0 nylon or polypropylene. By using the skin, the fascia is spared and the incidence of postoperative fascial dehiscence may be diminished.

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Media file 8: Artificial burr attaching the loop sheet to the right fascia. Courtesy of Wittmann, et al.

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Artificial burr attaching the loop sheet to the right fascia. Courtesy of Wittmann, et al.

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Media file 9: Artificial burr attaching the hook sheet to the left fascia. Courtesy of Wittmann, et al.

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Artificial burr attaching the hook sheet to the left fascia. Courtesy of Wittmann, et al.

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Media file 10: Two sheets of Velcro-like biocompatible material are sewn to the midline fascia. The Velcro-like material can be adjusted to accommodate increased intra-abdominal pressure (IAP), or, as the IAP decreases, it may be trimmed and the incision approximated accordingly. Courtesy of Wittmann, et al.

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Two sheets of Velcro-like biocompatible material are sewn to the midline fascia. The Velcro-like material can be adjusted to accommodate increased intra-abdominal pressure (IAP), or, as the IAP decreases, it may be trimmed and the incision approximated accordingly. Courtesy of Wittmann, et al.

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Media file 11: Gore-Tex 2-mm mesh is sewn to itself and to the skin or fascia (as in this case) to achieve temporary closure.

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Gore-Tex 2-mm mesh is sewn to itself and to the skin or fascia (as in this case) to achieve temporary closure.

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Media file 12: Marlex mesh is sewn to itself and to the fascia.

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Marlex mesh is sewn to itself and to the fascia.

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Media file 13: Dexon absorbable mesh is sewn to the fascia.

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Dexon absorbable mesh is sewn to the fascia.

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Media file 14: Close-up view of Dexon mesh.

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Close-up view of Dexon mesh.

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Media file 15: Presterilized (gas), 3-L, cystoscopy irrigation bag.

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Presterilized (gas), 3-L, cystoscopy irrigation bag.

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Media file 16: Opened, gas sterilized, 3-L, cystoscopy irrigation bag.

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Opened, gas sterilized, 3-L, cystoscopy irrigation bag.

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Media file 17: Example of massive edema of the bowel and liver in a patient who experienced blunt trauma and developed abdominal compartment syndrome (ACS).

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Example of massive edema of the bowel and liver in a patient who experienced blunt trauma and developed abdominal compartment syndrome (ACS).

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Media file 18: Same patient as in Media file 17. Note the distended small bowel loops.

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Same patient as in Media file 17. Note the distended small bowel loops.

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Media file 19: Demographic data for 15 patients requiring temporary abdominal IV bag closure. Courtesy of Fernandez L, Norwood S, Roettger R, et al. Temporary intravenous bag silo closure in severe abdominal trauma. J Trauma 1996; 40: 258-260.

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Demographic data for 15 patients requiring temporary abdominal IV bag closure. Courtesy of Fernandez L, Norwood S, Roettger R, et al. Temporary intravenous bag silo closure in severe abdominal trauma. J Trauma 1996; 40: 258-260.

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Media file 20: Cost comparison for abdominal closure materials. Courtesy of Fernandez L, Norwood S, Roettger R, et al. Temporary intravenous bag silo closure in severe abdominal trauma. J Trauma 1996; 40: 258-260.

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Cost comparison for abdominal closure materials. Courtesy of Fernandez L, Norwood S, Roettger R, et al. Temporary intravenous bag silo closure in severe abdominal trauma. J Trauma 1996; 40: 258-260.

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Media file 21: Comparison of materials considered for use in temporary abdominal closure. Courtesy of Fox V, Miller J, Nix M. Temporary abdominal closure using an IV bag silo for severe trauma. AORN J 1999 Mar; 69(3): 530-5, 537, 539-41.

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Comparison of materials considered for use in temporary abdominal closure. Courtesy of Fox V, Miller J, Nix M. Temporary abdominal closure using an IV bag silo for severe trauma. AORN J 1999 Mar; 69(3): 530-5, 537, 539-41.

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Media file 22: Placement of absorbable mesh.

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Placement of absorbable mesh.

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Media file 23: Split-thickness skin graft on a patient with multiple gunshot wounds and enteric fistulae.

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Split-thickness skin graft on a patient with multiple gunshot wounds and enteric fistulae.

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Media file 24: Approximation of the abdominal skin edges using the Sure-Closure device. Note that the abdominal silo resides in a partial intraperitoneal position.

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Approximation of the abdominal skin edges using the Sure-Closure device. Note that the abdominal silo resides in a partial intraperitoneal position.

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Media file 25: The Sure-Closure device in place.

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The Sure-Closure device in place.

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Media file 26: Approximation of the abdominal skin, creating a ventral hernia.

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Approximation of the abdominal skin, creating a ventral hernia.

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Media file 27: Patient with blunt trauma with nearly healed ventral hernia (subcutaneous flap advancement technique with the Sure-Closure device).

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Patient with blunt trauma with nearly healed ventral hernia (subcutaneous flap advancement technique with the Sure-Closure device).

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Media file 28: CT scan of a 25-year-old man who presented with 2 gunshot wounds to the abdomen. CT scan shows liver injury and abdominal distension, 8/30/01.

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CT scan of a 25-year-old man who presented with 2 gunshot wounds to the abdomen. CT scan shows liver injury and abdominal distension, 8/30/01.

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Media file 29: Open abdominal wound before placement of Vacuum Assisted Closure® (V.A.C.®) system, 8/30/01.

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Open abdominal wound before placement of Vacuum Assisted Closure® (V.A.C.®) system, 8/30/01.

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Media file 30: Vacuum-assisted closure (VAC) dressing applied, 8/30/01.

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Vacuum-assisted closure (VAC) dressing applied, 8/30/01.

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Media file 31: First wound clinic follow-up, 9/18/01.

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First wound clinic follow-up, 9/18/01.

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Media file 32: Demographic data for 15 patients requiring intraperitoneal silo procedures. Fernandez L, Norwood S, Wilkins H, et al. Intraperitoneal silo: a form of temporary abdominal closure. Surg Rounds 1999 Sept; 467-478.

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Demographic data for 15 patients requiring intraperitoneal silo procedures. Fernandez L, Norwood S, Wilkins H, et al. Intraperitoneal silo: a form of temporary abdominal closure. Surg Rounds 1999 Sept; 467-478.

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Media file 33: Comparison of materials considered for use in temporary abdominal closure. Courtesy of Fernandez L, Norwood S, Wilkins H, et al. Intraperitoneal silo: a form of temporary abdominal closure. Surg Rounds 1999 Sept: 467-478.

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Comparison of materials considered for use in temporary abdominal closure. Courtesy of Fernandez L, Norwood S, Wilkins H, et al. Intraperitoneal silo: a form of temporary abdominal closure. Surg Rounds 1999 Sept: 467-478.

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Media file 34: Presterilized, 3-L, cystoscopy irrigation bag. Courtesy of Fernandez L, Norwood S, Wilkins H, et al. Intraperitoneal silo: a form of temporary abdominal closure. Surg Rounds 1999 Sept: 467-478.

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Presterilized, 3-L, cystoscopy irrigation bag. Courtesy of Fernandez L, Norwood S, Wilkins H, et al. Intraperitoneal silo: a form of temporary abdominal closure. Surg Rounds 1999 Sept: 467-478.

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Media file 35: Epigastric slit. Courtesy of Fernandez L, Norwood S, Wilkins H, et al. Intraperitoneal silo: a form of temporary abdominal closure. Surg Rounds 1999 Sept; 467-478.

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Epigastric slit. Courtesy of Fernandez L, Norwood S, Wilkins H, et al. Intraperitoneal silo: a form of temporary abdominal closure. Surg Rounds 1999 Sept; 467-478.

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Media file 36: Silo in place within the peritoneal cavity. Courtesy of Fernandez L, Norwood S, Wilkins H, et al. Intraperitoneal silo: a form of temporary abdominal closure. Surg Rounds 1999 Sept; 467-478.

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Silo in place within the peritoneal cavity. Courtesy of Fernandez L, Norwood S, Wilkins H, et al. Intraperitoneal silo: a form of temporary abdominal closure. Surg Rounds 1999 Sept; 467-478.

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Media file 37: The surgeon removes the intraperitoneal silo.

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The surgeon removes the intraperitoneal silo.

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Media file 38: Appearance of the intraperitoneal silo after removal from the peritoneal cavity.

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Appearance of the intraperitoneal silo after removal from the peritoneal cavity.

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Media file 39: Appearance of the bowel after removal of the intraperitoneal silo.

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Appearance of the bowel after removal of the intraperitoneal silo.

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Media file 40: Diagram of silo placement within the abdominal cavity. Courtesy of Fernandez L, Norwood S, Wilkins H, et al. Intraperitoneal silo: a form of temporary abdominal closure. Surg Rounds 1999 Sept; 467-478.

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Diagram of silo placement within the abdominal cavity. Courtesy of Fernandez L, Norwood S, Wilkins H, et al. Intraperitoneal silo: a form of temporary abdominal closure. Surg Rounds 1999 Sept; 467-478.

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Media file 41: Cross-section of the abdomen with the intraperitoneal silo in place. Courtesy of Fernandez L, Norwood S, Wilkins H, et al. Intraperitoneal silo: a form of temporary abdominal closure. Surg Rounds 1999 Sept; 467-478.

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Cross-section of the abdomen with the intraperitoneal silo in place. Courtesy of Fernandez L, Norwood S, Wilkins H, et al. Intraperitoneal silo: a form of temporary abdominal closure. Surg Rounds 1999 Sept; 467-478.

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Media file 42: Beginning the skin closure. Courtesy of Fernandez L, Norwood S, Wilkins H, et al. Intraperitoneal silo: a form of temporary abdominal closure. Surg Rounds 1999 Sept; 467-478.

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Beginning the skin closure. Courtesy of Fernandez L, Norwood S, Wilkins H, et al. Intraperitoneal silo: a form of temporary abdominal closure. Surg Rounds 1999 Sept; 467-478.

More on Temporary Abdominal Closure Techniques

References

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Keywords

temporary abdominal closure, TAC, trauma damage-control celiotomy, damage control, damage-control celiotomy, damage-control surgery, damage control celiotomy, trauma damage control celiotomy, damage control surgery, abdominal compartment syndrome, ACS, intra-abdominal pressure, IAP, positive pressure ventilation, positive end expiratory pressure, intrathoracic pressure, central venous pressure, intracerebral pressure, intracranial pressure, abdominal wall, viscera, fascia, zipper closure, Wittmann Patch, synthetic mesh closure, polytetrafluoroethylene closure, marlex mesh, absorbable mesh, silastic closure, primary delayed fascial closure, Fabian protocol, Sure-Closure system, Sure-Closure Skin Stretching System, vacuum-assisted closure, VAC, vacuum-assisted fascial closure, VAFC, intraperitoneal silo, IP silo

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Luis G Fernandez, MD, FACS, FASAS, FCCP, FCCM, FICS, Assistant Clinical Professor of Surgery and Family Practice, University of Texas Health Science Center; Chairman, Division of Trauma Surgery and Surgical Critical Care, Chief of Critical Care Units, Trinity Mother Francis Health System
Luis G Fernandez, MD, FACS, FASAS, FCCP, FCCM, FICS is a member of the following medical societies: American Association for the Surgery of Trauma, American College of Chest Physicians, American College of Legal Medicine, American College of Surgeons, American Society of Abdominal Surgeons, American Society of General Surgeons, American Society of General Surgeons, American Society of Law Medicine and Ethics, American Trauma Society, Association for Surgical Education, Association of Military Surgeons of the US, Chicago Medical Society, Illinois State Medical Society, International College of Surgeons, New York Academy of Sciences, Pan American Trauma Society, Society of Critical Care Medicine, Society of Laparoendoscopic Surgeons, Southeastern Surgical Congress, Texas Medical Association, and Undersea and Hyperbaric Medical Society
Disclosure: Nothing to disclose.

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Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
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Managing Editor

David L Morris, MD, PhD, Professor, Department of Surgery, St George Hospital, University of New South Wales, Australia
Disclosure: Nothing to disclose.

CME Editor

Paolo Zamboni, MD, Professor of Surgery, Chief of Day Surgery Unit, Chair of Vascular Diseases Center, University of Ferrara, Italy
Paolo Zamboni, MD is a member of the following medical societies: American Venous Forum and New York Academy of Sciences
Disclosure: Nothing to disclose.

Chief Editor

John Geibel, MD, DSc, MA, Vice Chairman, Professor, Department of Surgery, Section of Gastrointestinal Medicine and Department of Cellular and Molecular Physiology, Yale University School of Medicine; Director of Surgical Research, Department of Surgery, Yale-New Haven Hospital
John Geibel, MD, DSc, MA is a member of the following medical societies: American Gastroenterological Association, American Physiological Society, American Society of Nephrology, Association for Academic Surgery, International Society of Nephrology, New York Academy of Sciences, and Society for Surgery of the Alimentary Tract
Disclosure: AMGEN Royalty Other; AstraZeneca Grant/research funds Other

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eMedicine Specialties > General Surgery > Abdomen

Temporary Abdominal Closure Techniques: Multimedia

Multimedia

Damage-control celiotomy in progress.

Edematous eviscerated bowel in a patient with blunt trauma.

Close-up view of edematous bowel.

Grading abdominal pressure. Courtesy of Saggi BH, Sugerman HJ, Ivatury RR, et al. Abdominal compartment syndrome. J Trauma 1998; 45: 597-609.

Left lateral thoracotomy with towel clip closure of damage-control celiotomy. Courtesy of Pedro Gustavo R. Teixeira, Trauma Surgeon, Brazil, The Trauma Imagebank.

Evisceration of the bowel (as illustrated) may occur if towel clips are not placed properly (1 cm from skin edge X 1 cm apart). This temporizing measure may not decompress the abdomen adequately. Intra-abdominal pressures as high as 50 mm Hg have been obtained with this type of closure technique.

Either a conventional zipper or a commercial zipper is sewn to the skin or fascia with a continuous suture of 0 or 2-0 nylon or polypropylene. By using the skin, the fascia is spared and the incidence of postoperative fascial dehiscence may be diminished.

Artificial burr attaching the loop sheet to the right fascia. Courtesy of Wittmann, et al.

Artificial burr attaching the hook sheet to the left fascia. Courtesy of Wittmann, et al.

Two sheets of Velcro-like biocompatible material are sewn to the midline fascia. The Velcro-like material can be adjusted to accommodate increased intra-abdominal pressure (IAP), or, as the IAP decreases, it may be trimmed and the incision approximated accordingly. Courtesy of Wittmann, et al.

Gore-Tex 2-mm mesh is sewn to itself and to the skin or fascia (as in this case) to achieve temporary closure.

Marlex mesh is sewn to itself and to the fascia.

Dexon absorbable mesh is sewn to the fascia.

Close-up view of Dexon mesh.

Presterilized (gas), 3-L, cystoscopy irrigation bag.

Opened, gas sterilized, 3-L, cystoscopy irrigation bag.

Example of massive edema of the bowel and liver in a patient who experienced blunt trauma and developed abdominal compartment syndrome (ACS).

Same patient as in Media file 17. Note the distended small bowel loops.

Demographic data for 15 patients requiring temporary abdominal IV bag closure. Courtesy of Fernandez L, Norwood S, Roettger R, et al. Temporary intravenous bag silo closure in severe abdominal trauma. J Trauma 1996; 40: 258-260.

Cost comparison for abdominal closure materials. Courtesy of Fernandez L, Norwood S, Roettger R, et al. Temporary intravenous bag silo closure in severe abdominal trauma. J Trauma 1996; 40: 258-260.

Comparison of materials considered for use in temporary abdominal closure. Courtesy of Fox V, Miller J, Nix M. Temporary abdominal closure using an IV bag silo for severe trauma. AORN J 1999 Mar; 69(3): 530-5, 537, 539-41.

Placement of absorbable mesh.

Split-thickness skin graft on a patient with multiple gunshot wounds and enteric fistulae.

Approximation of the abdominal skin edges using the Sure-Closure device. Note that the abdominal silo resides in a partial intraperitoneal position.

The Sure-Closure device in place.

Approximation of the abdominal skin, creating a ventral hernia.

Patient with blunt trauma with nearly healed ventral hernia (subcutaneous flap advancement technique with the Sure-Closure device).

CT scan of a 25-year-old man who presented with 2 gunshot wounds to the abdomen. CT scan shows liver injury and abdominal distension, 8/30/01.

Open abdominal wound before placement of Vacuum Assisted Closure® (V.A.C.®) system, 8/30/01.

Vacuum-assisted closure (VAC) dressing applied, 8/30/01.

First wound clinic follow-up, 9/18/01.

Demographic data for 15 patients requiring intraperitoneal silo procedures. Fernandez L, Norwood S, Wilkins H, et al. Intraperitoneal silo: a form of temporary abdominal closure. Surg Rounds 1999 Sept; 467-478.

Comparison of materials considered for use in temporary abdominal closure. Courtesy of Fernandez L, Norwood S, Wilkins H, et al. Intraperitoneal silo: a form of temporary abdominal closure. Surg Rounds 1999 Sept: 467-478.

Presterilized, 3-L, cystoscopy irrigation bag. Courtesy of Fernandez L, Norwood S, Wilkins H, et al. Intraperitoneal silo: a form of temporary abdominal closure. Surg Rounds 1999 Sept: 467-478.

Epigastric slit. Courtesy of Fernandez L, Norwood S, Wilkins H, et al. Intraperitoneal silo: a form of temporary abdominal closure. Surg Rounds 1999 Sept; 467-478.

Silo in place within the peritoneal cavity. Courtesy of Fernandez L, Norwood S, Wilkins H, et al. Intraperitoneal silo: a form of temporary abdominal closure. Surg Rounds 1999 Sept; 467-478.

The surgeon removes the intraperitoneal silo.

Appearance of the intraperitoneal silo after removal from the peritoneal cavity.

Appearance of the bowel after removal of the intraperitoneal silo.

Diagram of silo placement within the abdominal cavity. Courtesy of Fernandez L, Norwood S, Wilkins H, et al. Intraperitoneal silo: a form of temporary abdominal closure. Surg Rounds 1999 Sept; 467-478.

Cross-section of the abdomen with the intraperitoneal silo in place. Courtesy of Fernandez L, Norwood S, Wilkins H, et al. Intraperitoneal silo: a form of temporary abdominal closure. Surg Rounds 1999 Sept; 467-478.

Beginning the skin closure. Courtesy of Fernandez L, Norwood S, Wilkins H, et al. Intraperitoneal silo: a form of temporary abdominal closure. Surg Rounds 1999 Sept; 467-478.

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