• Affects about 2% of mid-line laparotomy wounds
• Serious complication with a mortality of up to 30%
• Due to failure of wound closure technique
  • Broken sutures or slipped knots
  • Inadequate muscle bites
• Usually occurs between 7 and 10 days post operatively
• Often heralded by serosanguinous discharge from wound
• Should be assumed that the defect involves the whole of the wound

Picture provided by R P R Groenedijk, IJselland Hospital, Capille ad IJssel, Nederlands

Management

• Opiate analgesia
• Sterile dressing to wound
• Fluid resuscitation
• Early return to theatre
• Resuture under general anaesthesia
• Exact technique is variable
• Interrupted or mass closure with non-absorbable sutures often used
• The use of 'deep tension' sutures is controversial
• Believed by some to strangulate muscle and weaken the closure
• Also painful and associated with increased risk of infection

Bibliography

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