Management of the difficult abdominal closure.

Hemorrhagic shock and multiple trunk injuries, especially severe pelvic fracture, may cause massive swelling of intra-abdominal viscera and the abdominal wall, thereby precluding safe, primary abdominal wall closure. Primary closure, under tension in such patients, causes a multitude of problems including respiratory compromise, reduced cardiac output, oliguria, enterocutaneous fistulae, impaired abdominal wall nutrient blood supply, necrotizing fasciitis, evisceration, and death of the patient. Multiple methods have been described to aid the surgeon in circumventing these problems. The authors advocate the abdominal wall pack technique, which has the advantages of ease of implementation and a low rate of wound complications.