Dynamic Retention Suture Closure: Modified Bogotá Bag Approach

Abstract

Management of patients with abdominal compartment syndrome requires abdominal decompression and the use of the open abdomen technique. Various options exist for the management of the open abdomen including expensive, commercially available devices to aid in the gradual closure of the abdominal wall. A previously described temporary closure technique using dynamic retention sutures was modified and used in eleven trauma injured patients at the Puerto Rico Trauma Center. Retrospective case series of 11 trauma patients, seven blunt and four penetrating, treated at the Puerto Rico Trauma Center with the modified Bogotá bag (MBB) approach from October 2005 to November 2006. The MBB approach was applied in 11 out of 43 trauma patients (26%) who had undergone a Bogotá bag closure during an initial damage control surgery. Patients' average age was 27.5 (2-65) y old, including 8 males and 3 females, with an injury severity score (ISS) of 23.3 (9-38). The MBB placement allowed serial approximation in the Trauma ICU with subsequent delayed primary abdominal closure. The procedure was used for an average of 7.3 (4-12) d. Abdominal closure was achieved in 10 out of 11 patients (91%). The MBB technique has preliminarily proven to be effective, allowing delayed primary closure in 91% of the cases. The MBB approach represents an inexpensive and useful alternative in the management of the open abdomen.