Reconstruction of abdominal wall in trauma patients after damage control

Reconstruction of the abdominal wall in trauma patients after damage control requires a well-thought-out management plan. In addition, there is a need for early recognition and initiation of damage control principles, optimizing resuscitation while being mindful of fluid overload, selective ventilation strategies, aggressive nutritional support, and infection management. The abdomen is initially managed with one of several temporary abdominal wall closure options. Each has advantages and disadvantages as the ideal closure method has yet to be defined. Regardless of which method is chosen, preventing loss of abdominal wall domain remains the key objective. Timing and patient selection are key factors in successful early abdominal wall closure. Aggressive diuresis after hemodynamic stabilization assists in reducing abdominal wall edema and facilitating early closure. When early closure is not possible, assessing the health of skin and fascia serves as a key step in determining management. In patients with sufficient skin, the fascia is assessed and management planned accordingly. For those with insufficient skin, we recommend considering the use of tissue expanders or complex tissue rearrangement techniques. A few select patients may require panniculectomy at time of operation to facilitate optimal closure. For patients with sufficient fascia, we recommend primary fascial closure with mesh onlay. For patients who have significant loss of abdominal domain and whose fascia is insufficient for primary closure, we recommend either component separation with subsequent primary fascial closure and mesh onlay or interpositional mesh with mesh onlay.