Management of the difficult abdominal closure

Primary closure of the abdominal wound following laparotomy in patients with hemorrhagic shock, massive transfusions, swollen abdominal viscera, and loss of compliance of the abdominal wall cannot be achieved without excessive tension. Persistence at primary closure in such patients leads to respiratory compromise, oliguria, enterocutaneous fistula, impaired abdominal wall nutrient blood flow, necrotizing fasciitis, evisceration, and sometimes death of the patient. A method of closure using an abdominal wall pack consisting of fluff gauze and rayon cloth is described. This method allows for fascia approximation and secondary wound healing without hernia in about 7 to 10 days as the patient enters the diuretic phase of resuscitation.