The 1–2–3 Approach to Abdominal Packing

Background Abdominal packing (AP) in damage-control laparotomy (DCL) is a lifesaving technique that controls coagulopathic hemorrhage in severely injured trauma patients. However, the impact of the duration of AP on the incidence of re-bleeding and on intra-abdominal infections in penetrating abdominal trauma is not clear. The objective of the present study was to evaluate the complications related to the duration of AP and to determine the optimal time for AP removal. Methods Prospectively collected/retrospectively analyzed data at an urban level I trauma center from January 2003 to December 2010 were used as the basis for this study. Inclusion criteria were adults (≥18 years old) with penetrating abdominal trauma, who had survived both the initial DCL procedure and their first re-laparotomy. All initial DCL patients included in the study underwent abdominal packing for coagulopathic hemorrhage control. The outcome measures of this study were re-bleeding after packing removal, intra-abdominal infection, and 30-day cumulative mortality. We considered time after packing as an independent variable. This was defined as the total amount of time (in days) that the packs were left in the patient’s abdomen. Patients were grouped according to the duration in days of their AP in 3 days. Results Of 503 patients with penetrating abdominal trauma, 121 underwent DCL and AP. The mean age was 30.1 ± 11.5 years, and the male to female ratio was 9:1. The mean Acute Physiology and Chronic Health Evaluation (APACHE II) score was 17.6 ± 7.2. The mean Injury Severity Score (ISS) score was 24.9 ± 9.1. The right upper quadrant was packed in 39 (32.2 %) patients, retroperitoneum in 70 (57.8 %), pelvis in 13 (10.7 %), and left upper quadrant in 9 (7.4 %). Fifty-one patients (42.1 %) had associated colon injuries and 58 (47.9 %) had small bowel injuries. Twenty-six patients (21.5 %) had AP 3 days. The re-bleeding rate in patients packed for 1–2 days compared to those packed for 3