55 yrs-old man recovering from a partial hepatectomy

Discussion in 'MRCS Forum' started by Lona., Oct 26, 2007.

  1. Lona.

    Lona. Guest

    On postoperative day 3, an otherwise healthy 55 yrs-old man recovering from a partial hepatectomy is noted to have scant serosanguineous drainage from his abdominal incision. His skin staples are removed, revealing a 1.0-cm dehiscence of the upper midline abdominal fascia. Which of the following actions is most appropriate?
    a- Removing all suture material and packing the wound with moist sterile gauze
    b- Starting intravenous antibiotics
    c- Placing an abdominal (Scultetus) binder
    d- Prompt resuturing of the fascia in the operating room
    e- Bed rest
  2. Lona.

    Lona. Guest

    Answer: c- Placing an abdominal (Scultetus) binder. (Sabiston, 15/e, pp 344-345) Serosanguineous drainage is classically associated with fascial dehiscence. A reasonable approach to this problem is to remove several sutures and gently explore the wound to determine the extent of the dehiscence. A small fascial dehiscence (1 to 2 cm) can be treated conservatively with local wound care and an abdominal binder to support the fascia. A larger dehiscence requires reoperation for formal reclosure of the fascia. High-risk patients with a large fascial dehiscence may be treated with an abdominal binder and modified bed rest, which allows both intraabdominal adhesion formation and local granulation. Although fascial dehiscence can occur from local infection, is usually not an infectious process and does not require parenteral antibiotic therapy.

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