To close or not to close: Managing the open abdomen

Abstract

No matter what your previous experience or surgical practice has been, you will extensively use and be exposed to damage control abdominal surgery and the open abdomen in combat or disaster surgery. If you are looking for level I, evidence-based medicine on how to approach and manage these patients, you are out of luck. You may have seen multiple different techniques of temporary abdominal closure and approaches to achieving definitive abdominal closure, many of which claim to be the optimal approach. Like most things in surgery, there is more than one way to achieve an excellent outcome for your patient. The critical factors are to develop a thorough understanding of the basic principles and pitfalls of open abdominal management, as well as your local capabilities and limitations. This chapter outlines a general approach to the open abdomen based on years of experience with combat casualties in the Iraq and Afghanistan conflicts. The basic principles outlined here are universal, but the details and techniques can and should be adapted or adjusted based on your individual situation and the realities on the ground.