Skin-only closure as a temporary abdominal closure technique in a rural setting – exploring role and safety profile

Abstract

Background: Acute laparotomy for trauma or sepsis often prevents definitive closure due to need for relook laparotomy or to prevent abdominal compartment syndrome. Skin-only closure is widely used in our setting. In this study, we review the safety and effectiveness of this technique.
Methods: Patients presenting with intra-abdominal pathology undergoing acute laparotomy and then subsequent skinonly closure using 2-0 prolene were included in the study and followed postoperatively for a three-month period for adverse events stratified by Clavien–Dindo grading, and rate of definitive closure.
Results: During the study period, twenty-five patients underwent emergent laparotomy and skin-only closure. The median age of patients undergoing skin-only closure was 27 years (standard deviation 9.1). Six patients presented with major trauma and 19 presented with sepsis. Twenty-one patients underwent subsequent fascial closure. One patient was unable to undergo fascial closure and was managed as a planned ventral hernia. Fourteen patients developed a postoperative complication. There were no deaths and no readmissions to intensive care. Three further patients developed a ventral hernia.
Conclusion: Skin-only closure, in carefully selected patients, is a feasible alternative to other temporary abdominal closure techniques in a resource-constrained setting.