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Fascial dehiscence (FD) after trauma laparotomy is associated with technical failure, wound sepsis, or intra-abdominal infection (JAI). The association of IAI with FD is inadequately evaluated. Knowing about its presence is essential to guide clinical diagnosis and management. Our objective was to identify the incidence and risk factors of IAI in patients with FD. We performed a medical record review of 55 trauma patients with FD. Patients with IAI were compared to patients without IAI and FD patients to all trauma laparotomy patients during the same period. Statistical significance was at P < 0.05. Thirty-nine (71%) FD patients had IAI, significantly higher than all trauma laparotomies (4.6%, P < 0.0001). Only 31 per cent of patients underwent laparotomy and drainage while 69 per cent received CT-guided percutaneous drainage followed by expectant management. Similarly, 33 per cent of the non-IAI group had operative management. No differences were found between the two groups in any of the examined factors. The majority of trauma patients with FD have IAI. No clinical or laboratory factors help identify FD patients likely to have IAI. Therefore, FD should be viewed as a sign of possible underlying IAI. Appropriate radiographic imaging or direct visualization of the entire abdominal cavity should be pursued before managing the dehisced fascia.
FASCIAL DEHiscENCE (FD) is the separation of abdominal musculoaponeurotic layers following surgery. It complicates the course of 0.2 per cent to 5,8 per cent of patients with abdominal surgery.1 The incidence of FD has remained unchanged over the last 20 years, ranging from 15 per cent to 20 per cent.1 Although it is commonly assumed that FD is mainly related to technical error, the patient's underlying medical condition plays a significant role in the development of dehiscence.2 At ages over 65, the presence of wound infection, pulmonary disease, hemodynamic instability, ostomy within the incision, sepsis, obesity, uremia, malignancy, ascites, steroid use, and hypertension are risk factors for FD.1"3-4
The role of intra-abdominal infection (IAI) as a risk factor for FD has not adequately been explored. IAI is an important variable in the management algorithm of FD. In the absence of IAI, expectant management or simple repair of the dehiscence is justified. In the presence of IAI, additional therapies must be considered, including open or...