This document discusses abdominal wound dehiscence, providing definitions, epidemiology, causes, classification, clinical features, treatment, and prevention. It defines abdominal wound dehiscence as the separation of abdominal wound layers before complete healing. Risk factors include pre-operative issues like malnutrition or post-operative complications like infection. Treatment depends on the severity but may involve resuturing or supportive dressings. Prevention focuses on managing risk factors, using proper surgical techniques like tension-free closure, and avoiding post-op issues like infection.

1. ABDOMINAL WOUND
DEHISCENCE
Dr Umar Muh’d Aminu
Department of Surgery
ATBUTH Bauchi

2. Outline
• Introduction-
– Definition
– Epidemiology
• Causes
– Pre-operative
– Operative
– Post-operative
• Classification
• Clinical features
• Treatment
– Non-operative
– Operative
• Prevention
• Conclusion

3. Introduction
• Important cause of morbidity and mortality
among surgical patients
• Affects patients by increasing distress and
mortality; the attendants by increasing cost of
treatment; the surgeon for whom it is a
disturbing reality ; and the hospital resources
by increasing health care cost due to
prolonged hospital stay

4. Definition
• separation of the layers of an abdominal wound
before complete healing has taken place
• occurs when a wound fails to gain sufficient
strength to withstand stresses placed upon it. The
separation may occur when overwhelming forces
break sutures, when absorbable sutures dissolve
too quickly or when tight sutures cut through
tissues.

5. Epidemiology
• Occurs in 2% of
Laparatomies
• M:F=2:1
• All ages->>over 50yrs
• Commonest time of
disruption= 7-12 days
post operatively
• Emergency>>Elective
• Vertical
incisions>>>transverse
incisions

6. Epidemiology
Closure
• Mass vs. Layered Closure?
 Incidence of burst –
layered closure > mass
closure
• Interrupted vs.
Continuous Sutures?
 Interrupted suturing – low
incidence of bursts
• Peritoneal Closure or not?
 Suturing the peritoneal -
not vital to prevent Burst
Abdomen

7. Cause of Disruption
• Increased Intra-abdominal Pressure vs.
Weakness of Wound
• Pre-operatively vs. Operatively vs. Post-
operatively
• Patient factors vs. Physician factors

8. Pre-operatively
Causes of ↑ed IAP
• Chronic cough
• Vomiting
• Abdominal distension
• 4Bladder outflow
obstruction
Causes of Wound weakness
• Hypoprotienamia
• Vitamin C Deficiency
• Malignancy
• Anaemia
• Uraemia
• Prolonged Steroid
Therapy
• Jaundice
• Radiation

9. Operatively
Causes of ↑ed IAP
• Excessive tissue handling
• Failure to decompress
grossly distends bowel
Causes of Wound Weakness
• Vertical vs. Transverse
incision
• Damage to nerves after
subcostal or para-rectal
incision
• Use of absorbable sutures
to close rectus
• Poor suturing technique
• Persistent leakage of
pancreatic enzymes
• Failure of asepsis

10. Post-operatively
• Persistence of pre-operative factors
• Wound haematoma
• Wound infection
• Post-op ileus

11. Classification
• Superficial and Revealed-
– When skin and stitches are removed with
separation of skin and subcutaneous layers only
• Deep and Concealed
– There is separation of all layers of the abdominal
wall with exception of skin
• Complete and Revealed (Burst abdomen)
– Protrusion of loop of bowel or portion of
omentum

12. Clinical Features
Symptoms
• Nausea
• Fever
• Local pain/Discomfort
Signs
• Serosanguinous (pink)
or blood stained
discharge
• Bowel or omentum
protruding through the
wound spontaneously
after removal of sutures

13. Burst Abdomen

14. Treatment options
• Non-operative
• Operative

15. Non-operative treatment
• If patient is unstable and there has been no
evisceration
• Involves either gauze packing of the wound or
covering it with a sterile occlusive dressing

16. Non-operative treatment(cont’d)
• Abdominal binder may be used to support
disrupted abdominal wound

17. Non-operative treatment(cont’d)
• Vacuum Assisted Closure (VAC)
– Used in 10% of total patients
– Significantly reduces post operative infection
– Reduces the uses of antibiotics prescriptions
– Can be safely used in patients using anti-
coagulants

18. Non-operative treatment(cont’d)
• Wound may subsequently contract to closure
or if the patient’s condition improves, delayed
operative closure may be performed

19. Operative Treatment
• Resuscitation if shock (+)
• Reassurance
• Appropriate analgesics
• Nothing by mouth
• Nasogastric tube insertion and suction
• Antibiotic
• Cover the wound with saline soaked sterile towel and
transfer to OT
• Emergency operation for replacement of bowel and
re-suturing of wound

20. Operative Procedure
• Each coils of intestine are washed with normal saline gently
and thoroughly
• Return to abdominal cavity
• Clean the abdominal wall
• Re-approximated with through and through
monofilament nylon
• Buttressed by tension suture
• Abdominal wall is supported by many-tail bandage, Adhesive
plaster
• Post-operative -General build-up
-Treat/Avoid predisposing factors

21. Prevention
Preoperative
• Correct the precipitating factors
• Manage causes of increased intra-abdominal
pressure
• Omit medications like steroids if possible
• Prophylactic antibiotics
• GI decompression (Ryle’s tube suction) in case of
intestinal obstruction

22. Per-operative
• Reduce septic load –peritoneal toilet
• Choice of suture –non-absorbable suture for wound
closure
• Tension free closure
• Follow Jenkin’s rule in closing midline laparotomy
wound
– Mass closure technique (include peritoneum +
rectus sheath in closure)
– Continuous suture
– Suture should be FOUR times the length of the
incision and bites should be taken 1cm from the
wound edge at 1cm intervals

23. Post-operative
• Prevention of wound sepsis
• Manage causes of increased intra-abdominal
pressure and GI distension
• Urgent recognition and treatment of wound
dehiscence
• Follow-up

24. Conclusion
• Abdominal wound high mortality rate and no
single cause being responsible: rather it is a
multi factorial problem

25. Reference
• Principles and Practice of Surgery including Pathology in the
Tropics; 4th Edition; E A Badoe, E Q Archampong, J T da Rocha-
Afodu
• S H Waqar, Zafar Iqbal Malik, Asma Razzaq, M Tariq Abdullah,
Aliya Shaima, M A Zahid; Frequency And Risk Factors For
Wound Dehiscence/Burst Abdomen In Midline Laparotomies;
J Ayub Med Coll Abbottabad 2005;17(4)
• Kusum Meena, Shadan Ali, Awneet Singh Chawla, Lalit
Aggarwal, Suhani Suhani,Sanjay Kumar, Rehan Nabi Khan; A
Prospective Study of Factors Influencing Wound Dehiscence
after Midline Laparotomy; Surgical Science, 2013, 4, 354-358
http://dx.doi.org/10.4236/ss.2013.48070 Published Online
August 2013 (http://www.scirp.org/journal/ss)

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