Gunshot wound to the abdomen
A twenty two year old male presented to the trauma service in cardiac arrest following a GSW to the LUQ of the abdomen. Following successful resuscitative thoracotomy in the ED he underwent damage control celiotomy that revealed injuries to the left diaphragm, stomach, colon, left kidney, spleen, pancreas, and renal vasculature. On the third day a Wittmann Patch was sewn to the fascia. Every other day the patch was tightened as much as could be tolerated. On the fifteenth day he returned to the operating room for drainage of an abscess and again on the twentieth day for exploration and irrigation. Following this he was able to tolerate periodic patch tightening until the thirty-eighth day when the patch was removed. The small residual gap was bridged with a prosthetic and the skin was closed primarily.
Comment
The use of the patch allowed for easy re-entry into the abdominal cavity and drainage of the abscess. The ability to sequentially approximate the abdominal wall prevented significant loss-of-domain that would have certainly resulted in a large ventral hernia.
Soft underside of the loop sheet of patch sewn to the fascia prior to being tucked under opposing fascial edge. The hook sheet is sewn to the opposing fascia.
Approximation and tightening of patch with hook section.
Approximation was continued until only a small fascial gap remained.
Case report courtesy of
Alain C. Corcos, MD, FACS
Department of Surgery
Division of Multisystem Trauma
The Mercy Hospital of Pittsburgh
Pittsburgh, PA 15219