Abbreviated closure for remote damage control laparotomy in extreme environments: a randomized trial of sutures versus wound clamps comparing terrestrial and weightless conditions

From National Research Council Canada

DOIResolve DOI: https://doi.org/10.1016/j.amjsurg.2017.03.027
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Name affiliation
  1. National Research Council of Canada. Aerospace
FormatText, Article
Journal titleThe American Journal of Surgery
ISSN0002-9610
Volume213
Issue5
Pages862–869
Subjectexsanguination; operational medicine; tactical medicine; damage control surgery; surgical simulation
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.
Publication date
PublisherElsevier
LanguageEnglish
Peer reviewedYes
NPARC number23002587
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Record identifiere15e85fa-4a50-4f70-8664-5dc3762f5540
Record created2017-12-04
Record modified2020-03-16
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