Abdominal Wound Dehiscence and Incisional Hernia

Abstract

Abdominal wound failure is defined as failure of the incision to heal and to maintain a normal abdominal wall anatomy. It can be divided into acute or chronic. Wound dehiscence is an acute wound failure. It has an incidence of 2% and an associated mortality of 25%. It commonly presents with serosanguinous discharge from the wound in the first week of surgery. It ranges from superficial breakdown of the skin with intact deeper musculo-aponeurotic layers, to a complete failure of the wound and an exposure of the viscera, i.e. burst abdomen. Incisional hernia is a chronic wound failure. It is diagnosed at follow-up clinics or much later as a new referral. It has an incidence of 10–15%. Half of those do not become clinically apparent until more than 5 years after surgery. Approximately 60% are asymptomatic and mortality is rare. The fascial layer degenerates beneath an intact skin and the protruding abdominal viscera then lie in a subcutaneous sac vulnerable to trauma.