A technique for the management of the open abdomen in the presence of a fistula

Abstract

The third stage ofdamage control (DC III) is a critical phase of thepatient’s care. Following unpacking and restorationof gastrointestinal continuity, the final step of DC IIIis closure of the abdominal wall. Frequently, this isnotpossibleasaresultofcontinuedboweledemaorretroperitoneal hematoma. In these patients theabdomen has to be managed open, eventually fol-lowedbyeitherdelayedclosureortheplacementofan absorbable mesh and subsequent delayed skingrafting. Even with meticulous care and dailyabdominal washouts, the incidence of fistula forma-tion during this process is significant.