Abdominal wound dehiscence and incisional hernia

Abdominal wound dehiscence and incisional hernias are common problems facing the general surgeon. Both can be thought of as forms of `wound failure' and the risk factors are similar for both. Some of these may be avoided by sound surgical technique and correct patient preparation. The management of wound dehiscence ranges from simple dressings to emergency surgery to close a `burst abdomen' followed by a period of intensive care. The management of incisional hernias is a much bigger topic and encompasses various surgical techniques. This review will describe the aetiology of wound failure and the management of acute wound dehiscence. It will then go on to cover in more detail the assessment of patients presenting with incisional hernia as well as outlining the main surgical options available and some of the auxiliary techniques that are used to aid repair. Lastly the topic of laparostomy closure, an increasing problem due to the increasing numbers of patients undergoing major surgery, and the use of Vacuum Assisted Closure devices are briefly reviewed.