{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,27]],"date-time":"2026-06-27T23:50:40Z","timestamp":1782604240500,"version":"3.54.5"},"reference-count":30,"publisher":"BMJ","issue":"1","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["J R Army Med Corps"],"accepted":{"date-parts":[[2014,3,27]]},"published-print":{"date-parts":[[2015,3]]},"abstract":"<jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>The paradigm of Damage Control Surgery (DCS) has radically improved the management of abdominal trauma, but less well described are the options for managing the abdominal wall itself in an austere environment. This article describes a series of patients with complex abdominal wall problems managed at the UK-led Role 3 Medical Treatment Facility (MTF) in Camp Bastion, Afghanistan.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Method<\/jats:title>\n                  <jats:p>Contemporaneous review of a series of patients with complex abdominal wall injuries who presented to the Role 3 MTF between July and November 2012.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Five patients with penetrating abdominal trauma associated with significant damage to the abdominal wall were included. All patients were managed using DCS principles, leaving the abdominal wall open at the end of the first procedure. Subsequent management of the abdominal wall was determined by a multidisciplinary team of general and plastic surgeons, intensivists and specialist nurses. The principles of management identified included minimising tissue loss on initial laparotomy by joining adjacent wounds and marginal debridement of dead tissue; contraction of the abdominal wall was minimised by using topical negative pressure dressing and dermal-holding sutures. Definitive closure was timed to allow oedema to settle and sepsis to be controlled. Closure techniques include delayed primary closure with traction sutures, components separation, and mesh closure with skin grafting.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Discussion<\/jats:title>\n                  <jats:p>A daily multidisciplinary team discussion was invaluable for optimal decision making regarding the most appropriate means of abdominal closure. Dermal-holding sutures were particularly useful in preventing myostatic contraction of the abdominal wall. A simple flow chart was developed to aid decision making in these patients. This flow chart may prove especially useful in a resource-limited environment in which returning months or years later for closure of a large ventral hernia may not be possible.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/jramc-2014-000276","type":"journal-article","created":{"date-parts":[[2014,5,9]],"date-time":"2014-05-09T21:11:10Z","timestamp":1399669870000},"page":"46-52","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":7,"title":["Management of complex abdominal wall defects associated with penetrating abdominal trauma"],"prefix":"10.1136","volume":"161","author":[{"given":"G Suren","family":"Arul","sequence":"first","affiliation":[{"name":"212 Field Hospital, Sheffield, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B J","family":"Sonka","sequence":"additional","affiliation":[{"name":"Department of Surgery, William Beaumont Army Medical Centre, El Paso, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J B","family":"Lundy","sequence":"additional","affiliation":[{"name":"San Antonio Military Medical Centre, Joint Base Sane Antonio, San Antonio, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R F","family":"Rickard","sequence":"additional","affiliation":[{"name":"Department of Surgery, Royal Centre for Defence Medicine, Birmingham, UK"},{"name":"Derriford Hospital, Plymouth, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S L A","family":"Jeffery","sequence":"additional","affiliation":[{"name":"Department of Surgery, Royal Centre for Defence Medicine, Birmingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2014,5,9]]},"reference":[{"key":"2025081310303990000_161.1.46.1","doi-asserted-by":"publisher","DOI":"10.1097\/00005373-199309000-00008"},{"key":"2025081310303990000_161.1.46.2","doi-asserted-by":"publisher","DOI":"10.1136\/jramc-155-04-16"},{"key":"2025081310303990000_161.1.46.3","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.b1778"},{"key":"2025081310303990000_161.1.46.4","doi-asserted-by":"publisher","DOI":"10.1136\/jramc-146-03-05"},{"key":"2025081310303990000_161.1.46.5","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjsurg.2008.11.015"},{"key":"2025081310303990000_161.1.46.6","doi-asserted-by":"publisher","DOI":"10.1136\/jramc-155-04-12"},{"key":"2025081310303990000_161.1.46.7","doi-asserted-by":"crossref","first-page":"660","DOI":"10.1097\/01.sap.0000187181.59748.19","article-title":"VADER (vacuum-assisted dermal recruitment): a new method of wound closure","volume":"55","author":"Van der Velde","year":"2005","journal-title":"Ann Plast Surg"},{"key":"2025081310303990000_161.1.46.8","doi-asserted-by":"publisher","DOI":"10.1097\/00006534-199009000-00023"},{"key":"2025081310303990000_161.1.46.9","doi-asserted-by":"crossref","first-page":"779","DOI":"10.1001\/jamasurg.2013.2336","article-title":"Systemic review and meta-analysis of randomized clinical trials comparing primary vs delayed primary skin closure in contaminated and dirty abdominal incisions","volume":"148","author":"Bhangu","year":"2013","journal-title":"JAMA Surg"},{"key":"2025081310303990000_161.1.46.10","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9610(79)90148-X"},{"key":"2025081310303990000_161.1.46.11","doi-asserted-by":"publisher","DOI":"10.1097\/00000658-198305000-00005"},{"key":"2025081310303990000_161.1.46.12","first-page":"231","article-title":"Towel clips, silos and heroic forms of wound closure","volume":"6","author":"Feliciano","year":"1991","journal-title":"Adv Trauma Crit Care"},{"key":"2025081310303990000_161.1.46.13","first-page":"774","article-title":"Abdominal sepsis managed by leaving abdomen open","volume":"90","author":"Duff","year":"1981","journal-title":"Surgery"},{"key":"2025081310303990000_161.1.46.14","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1097\/00005373-198104000-00005","article-title":"Intra-abdominal packing for control of hepatic hemorrhage: a reappraisal","volume":"21","author":"Feliciano","year":"1981","journal-title":"J Trauma"},{"key":"2025081310303990000_161.1.46.15","first-page":"30","article-title":"Temporary closure of open abdominal wounds: the vacuum pack","volume":"61","author":"Brock","year":"1995","journal-title":"Am Surg"},{"key":"2025081310303990000_161.1.46.16","doi-asserted-by":"publisher","DOI":"10.1016\/j.suc.2006.09.011"},{"key":"2025081310303990000_161.1.46.17","doi-asserted-by":"crossref","first-page":"1150","DOI":"10.1007\/s00268-009-0005-7","article-title":"Update on open abdomen management: achievements and challenges","volume":"33","author":"Ivatury","year":"2009","journal-title":"World J Surg"},{"key":"2025081310303990000_161.1.46.18","doi-asserted-by":"publisher","DOI":"10.1097\/00000658-199406000-00007"},{"issue":"(Suppl.1)","key":"2025081310303990000_161.1.46.19","first-page":"S1","article-title":"Evidence-based recommendations for the use of negative pressure wound therapy in traumatic wounds and reconstructive surgery: steps towards an international consensus","volume":"42","author":"Runkel","year":"2011","journal-title":"Injury"},{"key":"2025081310303990000_161.1.46.20","doi-asserted-by":"crossref","first-page":"436","DOI":"10.1016\/j.injury.2010.02.027","article-title":"Topical negative pressure and military wounds\u2014a review of the evidence","volume":"42","author":"Fries","year":"2011","journal-title":"Injury"},{"key":"2025081310303990000_161.1.46.21","unstructured":"Taylor CJ Jeffery SL . Management of military wounds in the modern era Wounds UK. 2009;5:50 8."},{"key":"2025081310303990000_161.1.46.22","doi-asserted-by":"crossref","first-page":"832","DOI":"10.1097\/01.prs.0000299268.51008.47","article-title":"Vacuum-assisted closure for defects of the abdominal wall","volume":"121","author":"DeFranzo","year":"2008","journal-title":"Plast Reconstr Surg"},{"key":"2025081310303990000_161.1.46.23","doi-asserted-by":"publisher","DOI":"10.1097\/01.prs.0000222551.10793.51"},{"key":"2025081310303990000_161.1.46.24","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9610(01)00786-3"},{"key":"2025081310303990000_161.1.46.25","doi-asserted-by":"publisher","DOI":"10.1097\/01.sla.0000124291.09032.bf"},{"key":"2025081310303990000_161.1.46.26","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1097\/01.sla.0000086544.42647.84","article-title":"Staged management of giant abdominal wall defects: acute and long-term results","volume":"238","author":"Jernigan","year":"2003","journal-title":"Ann Surg"},{"key":"2025081310303990000_161.1.46.27","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0b013e31817fa451"},{"key":"2025081310303990000_161.1.46.28","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0b013e31817fa489"},{"key":"2025081310303990000_161.1.46.29","doi-asserted-by":"crossref","first-page":"E74","DOI":"10.1177\/000313481107700407","article-title":"Early definitive closure of abdomen using components separation technique after damage control surgery","volume":"77","author":"Ferguson","year":"2011","journal-title":"Am Surg"},{"key":"2025081310303990000_161.1.46.30","doi-asserted-by":"crossref","unstructured":"Nott D Veen H Matthew P . Damage control in the austere environment. Bulletein R Coll Surg 2014;96:82\u20133.","DOI":"10.1308\/003588414X13814021678150"}],"container-title":["Journal of the Royal Army Medical Corps"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/jramc-2014-000276","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,13]],"date-time":"2025-08-13T17:30:50Z","timestamp":1755106250000},"score":1,"resource":{"primary":{"URL":"https:\/\/militaryhealth.bmj.com\/lookup\/doi\/10.1136\/jramc-2014-000276"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2014,5,9]]},"references-count":30,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2015,2,19]]},"published-print":{"date-parts":[[2015,3]]}},"alternative-id":["10.1136\/jramc-2014-000276"],"URL":"https:\/\/doi.org\/10.1136\/jramc-2014-000276","relation":{},"ISSN":["0035-8665","2052-0468"],"issn-type":[{"value":"0035-8665","type":"print"},{"value":"2052-0468","type":"electronic"}],"subject":[],"published":{"date-parts":[[2014,5,9]]}}}