Abdominal wall closure

Question 1

What is a key principle for good closure of the abdominal wall?

Answer 1

Good closure starts with good entry into the abdomen

Question 2

What type of suture is recommended for the fascial layer closure?

Answer 2

Slowly absorbable monofilament suture (0 PDS)

Question 3

What is the recommended suture to wound ratio for closure?

Answer 3

4:1

Question 4

What type of dressing is used for epitheliasing wounds?

Answer 4

Non-adherent dressing

Question 5

What type of dressing is suitable for exudative wounds?

Answer 5

Absorbent dressing

Question 6

What is the definition of dehiscence?

Answer 6

Disruption of an abdominal wound closure with protrusion or evisceration of the abdominal contents

Question 7

When does dehiscence occur in relation to cutaneous healing?

Answer 7

Before cutaneous healing

Question 8

What distinguishes a hernia from dehiscence?

Answer 8

Hernias lie under well-healed skin

Question 9

What is an incisional hernia?

Answer 9

Abnormal protrusion of a viscus/abdominal contents through the musculoaponeurotic layers of a surgical scar

Question 10

What is the incidence rate of abdominal wound dehiscence?

Answer 10

<2%

Question 11

Which gender is more affected by abdominal wound dehiscence?

What age group is at greatest risk?

Answer 11

Males (M > F)

> 60 years

Question 12

What are the patient factors that predispose to dehiscence?

Answer 12

similar to those for hernia formation: Age, Smoking, Malnutrition/ low albumin, Diabetes Mellitus

Question 13

What are the intra-abdominal pressure factors contributing to dehiscence?

Answer 13

Obesity, ascites, pregnancy, prostatism

Question 14

What types of medications are associated with an increased risk of dehiscence?

Answer 14

Steroids, immunosuppression, cytotoxicity

Question 15

What other patient conditions can increase the risk of dehiscence?

Answer 15

Jaundice, anaemia, uraemia, COPD, malignancy

Question 16

What post-operative factors can lead to dehiscence?

Answer 16

Intra-abdominal straining (coughing, vomiting), Early return to heavy lifting/ manual labour

Question 17

What local wound complications can contribute to dehiscence?

Answer 17

Infection, haematoma, foreign body

Question 18

What is a key local wound factor in the context of dehiscence?

Answer 18

Devitalised tissue in wound

Question 19

How does previous radiation affect the risk of dehiscence?

Answer 19

It can increase the risk of dehiscence

Question 20

What are important surgical technique factors that can lead to dehiscence?

Answer 20

Incision type, Closure technique, Placement of drains & stomas, Failure to close fascia of laparoscopic trocar >10mm

Question 21

What is the ideal suture placement to minimize dehiscence risk?

Answer 21

Sutures 1cm apart, total length >4x the length of the wound

Question 22

What is the most common mechanism for dehiscence?

Answer 22

Sutures cutting out

Question 23

What are other mechanisms of dehiscence besides sutures cutting out?

Answer 23

Suture breakage, Knot slippage, Tissue protruding between sutures

Question 24

True or False: Sutures cutting out is the most common mechanism of dehiscence.

Answer 24

True

Question 25

Fill in the blank: The knot is still intact _______ of the time in cases of dehiscence.

Answer 25

95%

Question 26

What factors related to incision type can affect dehiscence?

Answer 26

Angulated, parallel

Question 27

What can happen if sutures are placed too tight or too spaced out?

Answer 27

Increased risk of dehiscence

Question 28

What is the classification of wound dehiscence based on depth?

Answer 28

- Superficial: invovles skin and subcutaneous tissue -Deep: involves fascial dehiscence - Partial: involves part of the wound - Complete: involves the entire length of the wound

Question 29

When does wound dehiscence typically occur post-operation?

Answer 29

≈ 5-10 days post-op ## Footnote This occurs before skin healing takes place.

Question 30

What signs may indicate wound dehiscence?

Answer 30

++ serous fluid, 'pop' sound, +/- Ileus or obstruction, +/- systemic illness ## Footnote Systemic illness may include dehydration and SIRS.

Question 31

How is wound dehiscence clinically diagnosed?

Answer 31

Clinical diagnosis, may require removal of skin sutures and palpation/direct inspection ## Footnote Direct inspection of fascial closure is essential for diagnosis.

Question 32

What is the first step in the management of wound dehiscence?

Answer 32

Resuscitate ## Footnote Initial management focuses on stabilizing the patient.

Question 33

What should be done to protect the bowel in case of wound dehiscence?

Answer 33

Cover bowel with soaked gauze swabs ## Footnote This is a critical step before surgical intervention.

Question 34

What is the next step after initial management of wound dehiscence?

Answer 34

Return to theatre for re-suture ## Footnote Surgical intervention is necessary for proper closure.

Question 35

What are some complications associated with wound dehiscence?

Answer 35

Hernia complications, Sepsis ## Footnote Wound dehiscence can lead to serious complications if not managed promptly.

Question 36

Fill in the blank: Wound dehiscence is classified into _____ types based on depth.

Answer 36

four ## Footnote The four types are Superficial, Deep, Partial, and Complete.

Question 37

True or False: Wound dehiscence can occur before skin healing.

Answer 37

True ## Footnote It typically occurs 5-10 days post-operation.

Question 38

Describe good management of the open abdomen

Answer 38

TBa

Question 39

What is partial dehiscence?

Answer 39

A small defect that may heal with dressings, resulting in an eventual incisional hernia

Question 40

What is the mortality rate associated with complete dehiscence?

Answer 40

10-30%

Question 41

What is the subsequent incisional hernia rate after complete dehiscence?

Answer 41

Up to 50%