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

Andrew W Kirkpatrick; Jessica Lynn McKee; Colonel Homer Tien; Anthony J LaPorta; Kit Lavell; Tim Leslie; Paul B McBeth; Derek J Roberts; Chad G Ball; Damage Control Surgery in Austere Environments Research Group (DCSAERG)

doi:10.1016/j.amjsurg.2017.03.027

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

Am J Surg. 2017 May;213(5):862-869. doi: 10.1016/j.amjsurg.2017.03.027. Epub 2017 Mar 30.

Authors

Andrew W Kirkpatrick¹, Jessica Lynn McKee², Colonel Homer Tien³, Anthony J LaPorta⁴, Kit Lavell⁵, Tim Leslie⁶, Paul B McBeth⁷, Derek J Roberts⁸, Chad G Ball⁹; Damage Control Surgery in Austere Environments Research Group (DCSAERG)

Affiliations

¹ Canadian Forces Health Services, Nationwide, Canada; Department of Surgery, University of Calgary, Calgary, AB, Canada; Department of Critical Care Medicine, University of Calgary, Calgary, AB, Canada; The Regional Trauma Services Foothills Medical Centre, University of Calgary, Calgary, AB, Canada; University of Calgary, Calgary, AB, Canada. Electronic address: [email protected].
² Innovative Trauma Care, Edmonton, AB, Canada.
³ Canadian Forces Health Services, Nationwide, Canada; Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
⁴ Rocky Vista University School of Medicine, CO, USA.
⁵ Strategic Operations, San Diego, CA, USA.
⁶ Flight Research Laboratory, National Research Council of Canada, Ottawa, ON, Canada.
⁷ Department of Surgery, University of Calgary, Calgary, AB, Canada; Department of Critical Care Medicine, University of Calgary, Calgary, AB, Canada; The Regional Trauma Services Foothills Medical Centre, University of Calgary, Calgary, AB, Canada; University of Calgary, Calgary, AB, Canada.
⁸ Department of Surgery, University of Calgary, Calgary, AB, Canada; University of Calgary, Calgary, AB, Canada.
⁹ Department of Surgery, University of Calgary, Calgary, AB, Canada; The Regional Trauma Services Foothills Medical Centre, University of Calgary, Calgary, AB, Canada; University of Calgary, Calgary, AB, Canada.

PMID: 28390649
DOI: 10.1016/j.amjsurg.2017.03.027

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.

Trial registration: ID ISRCTN/77929274.

Keywords: Damage control surgery; Exsanguination; Operational medicine; Surgical simulation; Tactical medicine.

Publication types

Randomized Controlled Trial

MeSH terms

Abdominal Wound Closure Techniques* / instrumentation
Adult
Extreme Environments*
Humans
Laparotomy*
Male
Models, Anatomic
Suture Techniques* / instrumentation
Weightlessness*