Wound Failure in Laparotomy: New insights

Abstract

Wound failure is a common complication of abdominal surgery. Its clinical presentation can vary from superficial wound dehiscence to burst abdomen with intraabdominal organs protruding through the wound. In long term, incisional hernia can be considered a representation of abdominal wound failure.

The abdomen is the space between the diaphragm and the pelvic musculature. Abdominal organs are retained within the abdominal space and protected from external trauma by the abdominal wall. The abdominal wall consists of various tissue layers. Solidity of the abdominal wall is partly based on the different muscle fibre directions. The rectus abdominis muscle (or ‘straight muscle’) consists of two vertical parts, separated by the linea alba, this is a layer of connective tissue. Function includes bending of the thorax and lifting of the pelvis. The transverse abdominis muscles (or ‘horizontal muscles’) have horizontally directed muscle fibers and are located laterally to the rectus abdominis muscles. These muscles are separated from the internal organs by the posterior rectus fascia, the fascia transversalis and the peritoneum. The posterior rectus fascia only extends to the semicircular line of Douglas caudally. The transverse abdominis muscles are covered by the internal oblique abdominal muscles and the external oblique abdominal muscles, which can pull the ribs downwards, and bend and rotate the vertebral column. Finally, the abdominal muscles are covered by subcutaneous fat tissue and skin.