Muganga Dionizi, Basimbe Francis, Nayiga Irene, Ategeka Amanda, Malinga Paddy, Muwanga Twaha
Entebbe Regional Referral Hospital, Mother Kevin Post Graduate Medical School, Uganda Martyrs University, Nkozi, Uganda.
Mother Kevin Post Graduate Medical School, St. Francis Hospital Nsambya, Uganda Martyrs University, Nkozi, Uganda.
Case Rep Surg. 2025 Mar 25;2025:6862550. doi: 10.1155/cris/6862550. eCollection 2025.
: Necrosis of the rectus or lateral abdominal wall investing fascia may be associated with invasive infections or closure under extreme tension. This can lead to fascial dehiscence and evisceration of the intra-abdominal contents. Globally, abdominal wound dehiscence varies from 0.4% to 3.5% with associated mortalities reaching up to 45% in the perioperative period. Redo surgical operations and infectious complications are the major risk factors for abdominal wound dehiscence, but also presence of low albumin, glucocorticoid use, chest infections, and emergency surgeries have been also implicated. Open abdomen has been employed in incidences of trauma where a second look operation may be necessary, loss of abdominal wall, sepsis after penetrating abdominal trauma, and in cases of severe secondary peritonitis and acute pancreatitis. Patients with open abdomen are at a risk of fistula formation, sepsis, and loss of abdominal domain due to lateral fascial retraction. To reduce the mentioned complications mesh and nonmediated techniques to bridge fascia defects have been recommended with particular emphasis on biologic meshes with or without negative pressure wound therapy, component separation, or planned ventral hernia. We report a case of necrosis of the rectus and abdominal wound dehiscence and its management in a sub-Saharan setting, highlighting the challenges encountered and lessons learned. Retention sutures should be used cautiously in the management of wound dehiscence as it increases the risk of fascial necrosis in cases of intra-abdominal hypertension, as seen in our patient. In the absence of a VAC dressing, the utilization of routine saline gauze dressing promotes epithelialization over the exposed bowel and is a viable alternative to temporary abdominal closure modes of managing an open abdomen in a resource-limited setting.
腹直肌或腹壁外侧包绕筋膜的坏死可能与侵袭性感染或极度张力下的缝合有关。这可能导致筋膜裂开和腹腔内容物外露。在全球范围内，腹部伤口裂开的发生率为0.4%至3.5%，围手术期相关死亡率高达45%。再次手术和感染并发症是腹部伤口裂开的主要危险因素，但低白蛋白血症、使用糖皮质激素、肺部感染和急诊手术也与之有关。开放性腹部手术已应用于可能需要二次探查手术的创伤病例、腹壁缺损、穿透性腹部创伤后的脓毒症以及严重继发性腹膜炎和急性胰腺炎病例。开放性腹部手术患者有发生瘘管形成、脓毒症以及由于外侧筋膜回缩导致腹腔范围丢失的风险。为了减少上述并发症，推荐使用补片和非补片技术来修复筋膜缺损，尤其强调使用生物补片，可联合或不联合负压伤口治疗、成分分离或计划性腹侧疝修补术。我们报告了一例撒哈拉以南地区腹直肌坏死和腹部伤口裂开及其处理的病例，突出了所遇到的挑战和吸取的经验教训。在伤口裂开的处理中应谨慎使用保留缝线，因为如我们的患者所示，在腹腔高压情况下它会增加筋膜坏死的风险。在没有VAC敷料的情况下，使用常规盐水纱布敷料可促进暴露肠管的上皮化，并且是在资源有限环境中处理开放性腹部的临时腹部闭合模式的可行替代方法。
