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In reply

We thank Losanoff et al for their interest in recurrent ACS when a TAC has been used during a damage control procedure.¹ In response to the authors' concerns about ongoing bleeding as an undiscovered cause of ACS, we submit the following: at reexploration for our patients with open abdomen ACS, the intra-abdominal findings were almost uniformly the same and no doubt the result of ongoing reperfusion injury. All patients had massively distended, thickened bowel walls with free serous fluid and no evidence of surgical bleeding. As previously reported,^2-3 the technique of vacuum-pack open abdominal dressing is designed to drain free abdominal fluid from beneath the dressing via the negative pressure created from suction through the Jackson-Pratt drains. These lie between the intra-abdominal, nonadherent towel and the overlying Ioban drape (3M Health Care, St Paul, Minn). None of the patients in our series had expanding retroperitoneal hematomas or ongoing . . . [Full Text of this Article]

Corresponding author: Vicente H. Gracias, MD, Division of Traumatology and Surgical Critical Care, Department of Surgery, University of Pennsylvania School of Medicine, 3440 Market St, 1st Floor, Philadelphia, PA 19104-3335 (e-mail: graciasv@uphs.upenn.edu).

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Temporary Abdominal Coverage and Abdominal Compartment Syndrome
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Arch Surg. 2003;138(5):565.
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