Abdominal wound dehiscence and incisional hernia

Abdominal wound dehiscence and incisional hernias 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 further 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 contribution describes the causes of wound failure and the management of acute wound dehiscence. It covers the assessment of patients presenting with incisional hernia, as well as outlining the main surgical options available and some of the auxiliary techniques used to aid repair. Laparostomy closure (a problem due to the increasing numbers of patients undergoing major surgery and the relatively primitive understanding of abdominal compartment syndrome) is briefly reviewed.