{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,5]],"date-time":"2026-03-05T06:34:32Z","timestamp":1772692472060,"version":"3.50.1"},"reference-count":20,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2012,9,6]],"date-time":"2012-09-06T00:00:00Z","timestamp":1346889600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["1 D43 TW007560\u201001"],"award-info":[{"award-number":["1 D43 TW007560\u201001"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["World j. surg."],"published-print":{"date-parts":[[2012,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Abdominal packing (AP) in damage\u2010control 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\u2010bleeding and on intra\u2010abdominal 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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>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 (\u226518 years old) with penetrating abdominal trauma, who had survived both the initial DCL procedure and their first re\u2010laparotomy. All initial DCL patients included in the study underwent abdominal packing for coagulopathic hemorrhage control. The outcome measures of this study were re\u2010bleeding after packing removal, intra\u2010abdominal infection, and 30\u2010day 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\u2019s abdomen. Patients were grouped according to the duration in days of their AP in &lt;1, 1\u20132, 2\u20133, and &gt;3\u00a0days.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 503 patients with penetrating abdominal trauma, 121 underwent DCL and AP. The mean age was 30.1 \u00b1 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 \u00b1 7.2. The mean Injury Severity Score (ISS) score was 24.9 \u00b1 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\u2010one patients (42.1 %) had associated colon injuries and 58 (47.9 %) had small bowel injuries. Twenty\u2010six patients (21.5 %) had AP &lt;1\u00a0day, 42 patients (34.7 %) had AP between 1 and 2\u00a0days, 35 patients (28.9 %) had AP between 2 and 3\u00a0days, and 18 patients (14.8 %) had AP &gt;3\u00a0days. The re\u2010bleeding rate in patients packed for 1\u20132\u00a0days compared to those packed for &lt;1\u00a0day was a third lower, 14.3 %, (95 % confidence interval [95 % CI]: 8.06, 20.5) versus 38.5 % (95 % CI: 25.4, 51.5). Conversely, an increasing trend toward intra\u2010abdominal infection occurred as time after packing increased. The infection rate tripled from 16.7 % (95 % CI: 6.6, 26.7) to 44.4 % (95 % CI: 31.03, 57.7) when comparing 1\u20132\u00a0days versus &gt;3\u00a0days. Overall mortality was 16.5 %. Of these deaths, 8.26 % were attributable to re\u2010bleeding, and 13.2 % to intra\u2010abdominal infection. Deaths secondary to re\u2010bleeding seemed to decrease with time of AP, whereas intra\u2010abdominal infection deaths increased with time of AP (Chi square for trend <jats:italic>p<\/jats:italic> value = 0.04).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The present study suggests that AP used in the setting of DCL for coagulopathic hemorrhage control should not be removed prior to the first postoperative day because of the increased risk of re\u2010bleeding. The ideal length of AP is 2\u20133\u00a0days, and AP left in longer than 3\u00a0days is associated with a significantly increased risk of infectious complications.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00268-012-1745-3","type":"journal-article","created":{"date-parts":[[2012,9,5]],"date-time":"2012-09-05T17:14:14Z","timestamp":1346865254000},"page":"2761-2766","source":"Crossref","is-referenced-by-count":35,"title":["The 1\u20132\u20133 Approach to Abdominal Packing"],"prefix":"10.1002","volume":"36","author":[{"given":"Carlos","family":"Ordo\u00f1ez","sequence":"first","affiliation":[{"name":"Departamento de Cirug\u00eda Fundaci\u00f3n Valle del Lili Avenida Sim\u00f3n Bolivar, Carrera 98 N\u00famero 18\u201049 Cali Colombia"},{"name":"Unidad de Cuidado Intensivo Fundaci\u00f3n Valle del Lili Cali Colombia"},{"name":"Departamento de Cirug\u00eda Universidad del Valle Cali Colombia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luis","family":"Pino","sequence":"additional","affiliation":[{"name":"Departamento de Cirug\u00eda Fundaci\u00f3n Valle del Lili Avenida Sim\u00f3n Bolivar, Carrera 98 N\u00famero 18\u201049 Cali Colombia"},{"name":"Unidad de Cuidado Intensivo Fundaci\u00f3n Valle del Lili Cali Colombia"},{"name":"Departamento de Cirug\u00eda Universidad del Valle Cali Colombia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marisol","family":"Badiel","sequence":"additional","affiliation":[{"name":"Instituto de Investigaciones Cl\u00ednicas Fundaci\u00f3n Valle del Lili Cali Colombia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alvaro","family":"Sanchez","sequence":"additional","affiliation":[{"name":"Department of Surgery University of Pittsburgh Pittsburgh PA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jhon","family":"Loaiza","sequence":"additional","affiliation":[{"name":"Instituto de Investigaciones Cl\u00ednicas Fundaci\u00f3n Valle del Lili Cali Colombia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Oscar","family":"Ramirez","sequence":"additional","affiliation":[{"name":"Instituto de Investigaciones Cl\u00ednicas Fundaci\u00f3n Valle del Lili Cali Colombia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fernando","family":"Rosso","sequence":"additional","affiliation":[{"name":"Unidad de Cuidado Intensivo Fundaci\u00f3n Valle del Lili Cali Colombia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alberto","family":"Garc\u00eda","sequence":"additional","affiliation":[{"name":"Departamento de Cirug\u00eda Fundaci\u00f3n Valle del Lili Avenida Sim\u00f3n Bolivar, Carrera 98 N\u00famero 18\u201049 Cali Colombia"},{"name":"Unidad de Cuidado Intensivo Fundaci\u00f3n Valle del Lili Cali Colombia"},{"name":"Departamento de Cirug\u00eda Universidad del Valle Cali Colombia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marcela","family":"Granados","sequence":"additional","affiliation":[{"name":"Unidad de Cuidado Intensivo Fundaci\u00f3n Valle del Lili Cali Colombia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gustavo","family":"Ospina","sequence":"additional","affiliation":[{"name":"Unidad de Cuidado Intensivo Fundaci\u00f3n Valle del Lili Cali Colombia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew","family":"Peitzman","sequence":"additional","affiliation":[{"name":"Department of Surgery University of Pittsburgh Pittsburgh PA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juan Carlos","family":"Puyana","sequence":"additional","affiliation":[{"name":"Department of Surgery University of Pittsburgh Pittsburgh PA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael W.","family":"Parra","sequence":"additional","affiliation":[{"name":"Division of Trauma Critical Care Broward General Level I Trauma Center\/Delray, Provisional Level I Trauma Center Ft. 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