A A Novel Technique for the Damage Control of Huge Diaphragmatic Injuries


  • Boris Kessel




A novel technique for the damage control of big diaphragmatic injuries
Purpose: To evaluate and describe a novel technique for the temporary closure of
major diaphragmatic defects not suitable for primary suture in damage control setting.
Background: It is an acceptable opinion that all left sided diaphragmatic injuries
should be repaired, as opposed to right sided where the liver may safely protect the
defect. In most cases the repair of the diaphragm is simple, using non-absorbable
sutures. Closure of defects not suitable for primary suture, remains a really
challenging problem. Up today, there is no adequate solution for prevention of re-
protrusion of abdominal contents in a damage control setting.
Methods: We report a novel technique suitable for treating diaphragmatic injuries in
damage control setting. This method allows a rapid temporary closure of, non-suitable
for primary closure, large diaphragmatic defects and part of the damage control
Results: Two anesthetized pigs were used in an animal trial to evaluate the feasibility
of the technique. Same size defects were created in both subjects. In the first subject,
the defect was closed with a plastic (Bogota) bag. In the second subject, the
diaphragmatic defect was covered using a large abdominal pad. In both cases, no
chest protrusion was observed after completion of the experiment.
Conclusion: We describe a simple new technique for temporary diaphragmatic closure
that might be done as part of damage control. Further investigation will help to
include it to routine surgical arsenal.


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