Wound Dehiscence Part 2

This part explains age and sex distribution of disease, mechanism, diagnosis and best practices to prevent wound dehiscence.

Frequency of Burst Abdomen by Age and Sex:

Mechanisms for Wound Dehiscence:

Tearing of sutures through tissues (29%)
Infection (9%)
Broken suture (8%)
Facial necrosis (6%)
Loose knots (4%)
No explanation (44%)

Intervals between Day of operation and Bursting of abdomen:

Mean presentation of abdominal wound dehiscence was at
postoperative day 9 (range: 0–32 days), with 90% of all cases presenting
before the 15th postoperative day

Diagnostic Pointer:

Appearance of a pink, watery discharge through the wound a week or so after operation. This is blood-tinged peritoneal exudate escaping through the deeper layers of the wound, and its appearance is strong evidence of imminent complete dehiscence. Recognition of the significance of this discharge should make it possible to resuture the abdominal wound before the frightening and potentially dangerous complication of complete rupture is allowed to occur.
Lateral radiograph of the abdomen may confirm the diagnosis by showing bowel shadows very close to the skin of the wound area.

Recommendations:

Tension free Single Layered: “Mass Closure” of midline incisions
monofilament nonabsorbable suture
(suture length)SL: WL(wound length) between 4: 1 and 6: 1 with big loose bites gives conditions in the wound so that the effect of 30% wound lengthening leads to a rise in tension of less than 2%
Wide bites of the rectus sheath at least 1 cm from the edge of the incision. Drains are inserted through a separate stab away from the incision and a colostomy or ileostomy is always fashioned through a separate incision
Continous Closure or Interrupted closure

Technique of Abdominal Closure: