Wound dehiscence

Question 1

Ten days post right hemicolectomy, abdominal pain and pink fluid from wound. What would you do?

Answer 1

Phone:
- obs
- ask about symptoms
- ensuring pt stable and not medical emergency
A-E:
- inspect wound, wound swab
+:
- inform seniors

Question 2

Wound exam shows wound dehiscence. What would you do?

Answer 2

• inform senior, pt likely to need returning to theatre for wound exploration under GA
• d/w theatre coordinator
• reassess, inc abdo exam
• analgesia and antiemetic to prevent retching
• d/w pt, prepare consent if indicated, NBM, prep G+S

Question 3

Would you attempt to reduce the bowel on the ward and if so, how would you do this?

Answer 3

NO. abdominal wall rigidity would not allow this, and i could damage bowel, and cause pain
- cover exposed viscera with sterile towel or large dressing soaked in warm normal saline and bandage if necessary
- fast-bleep registrar
- prep pt for surgery (prep consent, NBM, G+S, X-m)

Question 4

What factors can lead to wound dehiscence?

Answer 4

Patient:
- comorbidities: anaemia, jaundice, malignancy, vitamin C deficiency, DM, protein deficiencies
- smoking

Periop:
- surgical technique
- suture technique, strain
- increased bowel handling inc oedema
- leakage of bowel contents

Postop:
- chronic cough - bronchitis, COPD
- obesity
- constipation
- SSI

Question 5

What is Jenkins rule?

Answer 5

• rule for closure of abdominal wound
• for a continuous suture, length of suture should be at least 4 tmies the length of the wound with sutures 1cm apart and with 1cm bites of the wound edge

Question 6

How should a wound dehiscence be repaired?

Answer 6

• non viable tissue should be debrided
• repair with interrupted nylon (non-absorbable) sutures in all layers of abdominal wall, fascia and peritoneum

Question 7

If the deep layer of the abdominal wound gives way, but the skin sutures stay intact,what is the diagnosis?

Answer 7

Incisional hernia