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The complicated septic abdominal wound.

J H Kendrick, R E Casali, N P Lang

    Archives of Surgery (Chicago, Ill. : 1960)
    |April 1, 1982
    PubMed
    Summary
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    This study presents surgical management for abdominal wall necrosis and fistulae in 21 patients. Effective treatments led to a 71% overall survival rate for these severe postoperative complications.

    Area of Science:

    • Surgical Management
    • Abdominal Wall Necrosis
    • Intestinal Fistulae

    Background:

    • Postoperative abdominal wall necrosis and associated fistulae present significant surgical challenges.
    • Severe cases include liquefaction necrosis, associated intestinal fistulae, and multiple bowel fistulae with peritoneal contamination.

    Purpose of the Study:

    • To describe and evaluate surgical management strategies for severe postoperative abdominal wall necrosis with various types of associated intestinal fistulae.
    • To report the overall survival rate for patients undergoing these surgical interventions.

    Main Methods:

    • Retrospective analysis of 21 patients treated between 1975 and present.
    • Group A (n=13): Exploratory laparotomy, abscess drainage, debridement, and Marlex mesh closure for fascial necrosis.

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  • Group B (n=3): Suture closure of bowel fistulae with skin flap coverage.
  • Group C (n=5): Diverting jejunostomy and distal fistula closure for multiple internal bowel fistulae.

    • Main Results:

    • Overall survival rate of 71% across all patient groups.
    • Specific management tailored to the type and severity of necrosis and fistulae.

    Conclusions:

    • Surgical interventions including laparotomy, debridement, mesh repair, fistula closure, and jejunostomy are effective in managing severe postoperative abdominal wall complications.
    • Tailored surgical approaches can achieve significant survival rates in complex cases.