Management of laparotomy wound dehiscence

Am Surg. 2007 Dec;73(12):1224-7.

Abstract

Many studies identify risk factors for dehiscence, but a paucity of data exist suggesting an optimal treatment strategy. This study examines repair of abdominal wound dehiscence, comparing closure and interposition of mesh. We conducted a retrospective review of 37 individuals who suffered a wound dehiscence after laparotomy. Outcomes of repairs with either primary closure or polyglactin mesh interposition were examined. Twenty-seven individuals underwent repair with primary closure. Twelve of these individuals suffered repeat wound dehiscence; 10 were treated with repeat fascial closure, 2 with polyglactin mesh interposition. Seven individuals initially underwent successful repair with polyglactin mesh interposition; all subsequently had their hernias repaired. Three patients had minor fascial separation managed nonoperatively. Primary closure is associated with a relatively high rate of recurrent wound dehiscence. Closure with polyglactin mesh interposition has a higher initial success rate, but necessitates additional surgeries for repair of the abdominal wall defect.

MeSH terms

  • Fasciotomy
  • Follow-Up Studies
  • Humans
  • Laparotomy / adverse effects*
  • Polyglactin 910*
  • Recurrence
  • Retrospective Studies
  • Risk Factors
  • Surgical Mesh*
  • Surgical Wound Dehiscence / etiology*
  • Surgical Wound Dehiscence / surgery*
  • Suture Techniques*
  • Treatment Outcome

Substances

  • Polyglactin 910