One hundred years of abdominal wound dehiscence and nothing has changed

Summary

The burst abdomen has been a constantly present complication in the last century. A collective review of the literature showed that predisposing, contributing, and causative factors have all been recognized early in the last century. The incidence of abdominal wound dehiscence has not changed appreciably. In a retrospective clinical study the incidence of wound disruption after 2030 median laparotomies was 1.3%. Inadequate knot and suture technique were causative, and layered closure needed revision. In an experimental study using rats, the healing of a midline defect of the abdominal wall was strengthened only by the addition of retention sutures, not by the use of supporting devices. In a prospective clinical study the abdominal wound was closed in one layer with large bites (> 1 cm) and with small steps (< 1 cm) of continuous PDS. Fifteen wound disruptions occurred (0.6%) after closure of 2488 median laparotomies. Scrutiny of the disrupted wounds revealed non-compliance with the suture protocol in the vast majority of cases. The surgeon is a prognostic factor in abdominal wound closure. Nothing has changed in 100 years.