title: Management of laparotomy wound dehiscence.
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.
authors.affiliation: Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL 60614, USA. abbottdan@sbcglobal.net
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Abbott
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Dumanian
authors.forename: Amy L
authors.initials: AL
authors.lastname: Halverson
mesh_terms: D000071938:Fasciotomy; D005500:Follow-Up Studies; D006801:Humans; D007813:Laparotomy / Q000009:adverse effects*; D011098:Polyglactin 910; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D013526:Surgical Mesh; D013529:Surgical Wound Dehiscence / Q000209:etiology* / Q000601:surgery*; D013536:Suture Techniques; D016896:Treatment Outcome
chemical_list: D011098:Polyglactin 910