- 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
Eke N, Jebbin N J. Abdominal wound dehiscence: a
review. Int Surg 2006; 91: 276-287.- |