Abbreviated closure for remote damage control laparotomy in extreme environments: A randomized trial of sutures versus wound clamps comparing terrestrial and weightless conditions - 27/09/17
, Jessica Lynn McKee, MSc f, Colonel Homer Tien, CD, MD, FRCSC a, g, Anthony J. LaPorta, Colonel (Ret)MD, FACS h, Kit Lavell, DFC i, Tim Leslie, MSc j, Paul B. McBeth, MD, FRCSC b, c, d, e, Derek J. Roberts, MD, PhD b, e, Chad G. Ball, MD, MSC, FRCSC, FACS b, d, eFor the Damage Control Surgery in Austere Environments Research Group (DCSAERG)
Abstract |
Introduction |
Far-Forward Damage Control Laparotomies (DCLs) might provide direct-compression of visceral hemorrhage, however, suturing is a limiting factor, especially for non-physicians. We thus compared abbreviated skin closures comparing skin-suture (SS) versus wound-clamp (WC), on-board a research aircraft in weightlessness (0g) and normal gravity (1g).
Methods |
Surgeons conducted DCLs on a surgical-simulator; onboard the hangered-aircraft (1g), or during parabolic flight (0g), randomized to either WC or SS.
Results |
Ten surgeons participated. Two (40%) surgeons randomized to suture in 0g were incapacitated with motion-sickness, and none were able to close in either 1 or 0g. With WC, two completely closed in 1g as did three in 0g, despite having longer incisions (p = 0.016). Overall skin-closure with WC was significantly greater in both 1g (p = 0.016) and 0g (p = 0.008).
Conclusions |
WC was more effective in 1g and particularly 0g. Future studies should address the utility of abbreviated WC abdominal closure to facilitate potential Far-Forward DCL.
Trial registration |
ID ISRCTN/77929274.
Le texte complet de cet article est disponible en PDF.Résumé |
Surgeons were randomized to close the laparotomy incision of a high-fidelity surgical simulator using either standard suturing (SS) or a wound-clamp (WC) for expedited damage control laparotomy (DCL) closure. Regardless of whether this closure task was performed in terrestrial gravity (1g) or weightlessness (0g), the WC was much more effective at allowing expedited DCL closure.
Le texte complet de cet article est disponible en PDF.Keywords : Exsanguination, Operational medicine, Tactical medicine, Damage control surgery, Surgical simulation
Plan
Vol 213 - N° 5
P. 862-869 - mai 2017 Retour au numéro
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