Treatment includes antimicrobials and surgical drainage and debridement of devitalized tissue. his typically requires spinal analgesia or general anesthesia. The fascia is carefully inspected to document integrity. Local wound care thereafter is completed twice daily. Before each dressing change, procedural analgesia is tailored to wound size and location, and oral, intramuscular, or intravenous dosage routes are suitable. Topical lidocaine may also be added. Necrotic tissue is removed, and the wound is repacked with moist gauze. At 4 to 6 days, healthy granulation tissue is typically present, and secondary en bloc closure of the open layers can usually be accomplished (Wechter, 2005). As shown in Figure 37-1, a polypropylene or nylon suture of appropriate gauge enters 2 to 3 cm from one wound edge. It crosses the wound to incorporate the full wound thickness and emerges 3 cm from the other wound edge. hese are placed in series to close the opening. In most cases, sutures may be removed on postprocedural day 10.
his system was designed to apply negative pressure to a foamwound interface that would promote wound healing. The technique is variably referred to as vacuum-assisted closure-VAC; topical negative pressure-TNP; and negative-pressure wound therapy-NPWT. Several systems are available and widely (Echebiri, 2015; Rouse, 2015; Swift, 2015). In obstetrics, disrupted and infected abdominal wounds are a major indica tion for vacuum-assisted closure. Closure of perineal wounds resulting from infected episiotomies, hematomas, or abscesses is another (Aviki, 2015). hese devices are also used for the "open surgical abdomen," which is occasionally encountered in obstetrics. Negative-pressure wound therapy has also been used to prevent wound infections in those closed to heal by primary intention.
wound closure with conventional wound care (Semsarzadeh, 2015). Likewise, its cost efectiveness has not been thoroughly studied, although provider time is decreased substantially (Lewis, 2014). From their review, Moues and colleagues (201l) wounds because of scarce data. Other reviewers conclude that vacuum therapy is the most eicient method of temporary abdominal closure for patients with open abdominal wounds (Bruhin, 2014; Quyn, 2012).
Wound disruption or dehiscence refers to separation of the fascial layer. This is a serious complication and requires secondary closure of the incision in the operating room. McN eeley and associates (1998) reported a fascial dehiscence rate of approximately 1 per 300 operations in almost 9000 women undergoing cesarean delivery. Other than wound infection, obesity may be a risk factor (Subramaniam, 2014). Most disruptions manifested on about the fifth postoperative day and were accompanied by a serosanguinous discharge. Two thirds of 27 fascial dehiscences identified in this study were associated with concurrent fascial infection and tissue necrosis.