Weighted Abdominal Traction for Assistance in Abdominal Closure: A Case Report of Two Patients
Wendy Jo Svetanoff,Charles Jason Smithers, Thomas Hamilton, Russell Jennings
Boston Children's Hospital Department of Surgery, Boston, MA, USA
Background: Loss of abdominal domain is an unsolved problem in many complex abdominal procedures. We report two patients who underwent weighted traction and use of retention sutures to prevent fascial retraction.
Cases: Our first patient had a caustic ingestion and underwent a jejunal interposition. Due to the procedure's length, the abdomen was left open. The fascia was sutured to a reinforced silastic silo, which was then placed on 30 pounds of traction. After 8 days, the patient's abdomen was able to be closed primarily. Our second patient had a history of esophageal atresia and presented with persistent aspiration. Due to concern for the health of her conduit, her abdomen was left open and placed on 30 pounds of traction. Once the abdomen was deemed suitable for closure, an abdominal vac was applied and the fascia was placed under continuous tension using #5 Ethibond sutures. Her abdomen was able to be fully closed 10 days later.
Conclusion: One of the concerns with temporary abdominal closure is retraction of the fascia during resuscitation. We report two cases where the fascia and abdominal wall were placed on weighted traction, allowing for retention of abdominal domain and delayed primary closure without the need for grafts or mesh. This approach adds to the options available to aid in closure of the complex abdomen.
Figure 1. A silastic silo was used for bowel protection, while the fascia and skin were suspended under 30 pounds of weighted traction.
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