Repair of recurrent midline abdominal wall dehiscence using the components separation technique

Published:April 14, 2008DOI:
      A 25-year-old male patient sustained a blunt trauma to the abdomen in a quarrel. He presented to the emergency department with the symptoms of internal haemorrhage, which was confirmed by abdominal ultrasonography. During exploratory surgery a massive retroperitoneal haematoma was evacuated but no source of bleeding could be identified. The following day, another exploration was performed as the haematoma had filled up again and this time the wound was closed leaving a pack of gauze that was gradually withdrawn over 2 days. There was a continuous chylous discharge through the wound. By the 8th postoperative day, the sutures were cutting through and the wound was widely gaping with exposed intestines. After daily dressing for 5 days, the wound was closed in the surgery department with tension sutures. Ten days later, the lower two-thirds of the wound were disrupted again. The patient was then referred to the plastic surgery department with a defect of 17×27 cm in diameter in the anterior abdominal wall, exposing the intestines. The wound edges were markedly macerated, ragged and partly covered with pyogenic membrane (Figure 1). Blood picture, serum glucose and liver and kidney functions were performed. Serum glucose, liver enzymes and renal functions were within normal ranges, while his haemoglobin concentration was 9.4 g/dl, white blood cells were 14.500/cc and serum albumin was 1.3 g/dl. The patient received one unit of blood and two units of plasma to correct the anaemia and hypoalbuminaemia.
      Figure thumbnail gr1
      Figure 1The post-laparotomy dehiscence showing the silk sutures cutting through, the gaping repair of the recti and the exposed bowel.
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