An experience in the management of the open abdomen in severely injured burn patients. J Burn Care Res 2012;33(4):491-6
Date
07/11/2012Pubmed ID
22777397DOI
10.1097/BCR.0b013e3182479b00Scopus ID
2-s2.0-84866061561 (requires institutional sign-in at Scopus site) 13 CitationsAbstract
Few descriptions of temporary abdominal closure for planned relaparotomy have been reported in burned patients. The purpose of this study is to describe our experience and outcomes in the management of burned patients with an open abdomen. The authors performed a retrospective review of all admissions to our burn center from March 2003 to June 2008, identifying patients treated by laparotomy with temporary abdominal closure. The authors collected data on patient demographics, indication for laparotomy, methods of temporary and definitive abdominal closure, and outcomes. Of 2,104 patients admitted, 38 underwent a laparotomy with temporary abdominal closure. Their median TBSA was 55%, and the incidence of inhalation injury was 58%. Abdominal compartment syndrome was the most common indication for laparotomy (82%) followed by abdominal trauma (16%). The in-hospital mortality associated with an open abdomen was 68%. Temporary abdominal closure was performed most commonly using negative pressure wound therapy (90%). Fascial closure was performed in 21 patients but was associated with a 38% rate of failure requiring reexploration. Of 12 survivors, fascial closure was achieved in seven patients and five were managed with a planned ventral hernia. Burned patients who necessitate an open abdomen management strategy have a high morbidity and mortality. Fascial closure was associated with a high rate of failure but was successful in a select group of patients. Definitive abdominal closure with a planned ventral hernia was associated with no increased mortality and remains an option when "tension-free" fascial closure cannot be achieved.
Author List
Hardin MO, Mace JE, Ritchie JD, Chung KK, Markell KW, Renz EM, Wolf SE, Blackbourne LH, White CEAuthor
James E. Mace MD Adjunct Assistant Professor in the Surgery department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
Abdominal InjuriesAbdominal Wound Closure Techniques
Adult
Burns
Cause of Death
Cohort Studies
Female
Follow-Up Studies
Hospital Mortality
Humans
Injury Severity Score
Laparotomy
Male
Military Personnel
Negative-Pressure Wound Therapy
Retrospective Studies
Risk Assessment
Surgical Mesh
Survival Rate
Treatment Outcome
Wound Healing
Young Adult
