Abstract: Role of Components Separation in War-Related Pediatric Abdominal Trauma (Plastic Surgery 2013)

Sunday, October 13, 2013: 11:00 AM

Ian L. Valerio, MD, MS, MBA, FACS , Plastic and Reconstructive Surgery Service, Walter Reed National Military Medical Center, Bethesda, MD

Jennifer Sabino, MD , General Surgery, Walter Reed National Military Medical Center, Bethesda, MD

Daniel Nicastri, MD , Cardiothoracic Surgery, Walter Reed National Military Medical Center, Bethesda, MD

Vu Nguyen, MD , Plastic and Reconstructive Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA

Christopher M. Hults, MD , General Surgery, University of Southern Florida, Tampa, FL

Peter M. Hammer, MD , Acute Care Surgery and Surgical Critical Care, USC/Keck School of Medicine, Los Angeles, CA

Anand R. Kumar, MD , Pediatric Plastic Surgery, University of Pittsburgh, Children's Hospital of Pittsburgh, Pittsburgh, PA

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Introduction: Trauma and reconstruction surgeons in the deployed military theater are often exposed to devastating and significant pediatric war-related injuries.¹ While extremity and craniofacial injuries are important considerations in the care of these children, the associated abdominal injuries secondary to penetrating ballistics and blast exposure can be immediately life-threatening, and careful management of such abdominal injuries are critical in the impact of survival for these children. The purpose of this review is to report our collective experience in managing pediatric abdominal trauma within the austere, battlefield environment with careful considerations to lessons learned during the last decade of war-related pediatric trauma.

Methods: A retrospective review of war-related pediatric trauma treated at the Role 3 Multinational Medical Unit, Kandahar, Afghanistan from October 2010 through January 2013 was reviewed. Data assessed included the severity of abdominal trauma, associated thoracic, perineal, extremity, and craniofacial injuries. Average surgical times, time to definitive abdominal closure and method of definitive closure, and complications were reviewed and reported.

Results: Of 383 pediatric patients treated, 41 cases were classified “thoracic” and 15 were classified as “abdominal.” The mechanism of injury was blast in the majority of cases. Component separation technique (CST) was performed on two pediatric patients, 12 months and 9 years of age, after traumatic war-related abdominal injury. There was no mortality in this series. The nine year old patient was discharged without complication or further intervention. The 12 month old patient developed a small bowel leak at the site of anastomosis, requiring re-exploration but primary fascial apposition was achieved at the end of the re-exploration without issue. The patient was discharged without further complication.

Conclusion: The last decade of war trauma has presented our military surgeons with a high volume of complex abdominal injuries including a significant experience in pediatric war-related penetrating and blast injuries. We successfully performed CST on pediatric patients with minimal complications and no occurrence of abdominal compartment syndrome. CST should be considered to treat traumatic ventral hernias in a pediatric population.

22240 Role of Components Separation in War-Related Pediatric Abdominal Trauma