Management of abdominal wounds in thermally injured patients

Over a 10-year period, 103 burned patients (mean age, 25 years; mean burn size, 43% of the total body surface) required an intra-abdominal operation. Life- threatening complications dictated operative intervention, and the complications resulted in increased mortality. Abdominal incisions dehisced in 33 patients. In 75 patients whose 91 incisions were closed with retention sutures, 18 wounds (20%) separated postoperatively, including seven in which synthetic sutures disrupted. In 28 patients whose 35 abdominal incisions were closed without retention sutures, 15 wounds (43%) dehisced. Placement of the abdominal incision through the burn wound appeared not to affect the incidence of dehiscence. When an abdominal operation is required in burned patients, their wounds should be closed by stainless steel wire, usually as retention sutures, placed through all muscle and fascial layers of the abdominal wall.