Definition & Overview
The debridement of the abdominal wall is a surgical procedure that often becomes necessary when patients develop necrotising fasciitis in the abdominal wall. The procedure, which can be life-saving in some cases, can be performed either as a standalone operation or in combination with a fascial closure.
Who Should Undergo and Expected Results
The procedure is for patients who have contaminated or infected wounds in the abdominal area that do not respond to antibiotics and have resulted in necrosis in the abdominal wall.
Necrosis in the abdominal wall can be caused by injury or post-operative infection. It has also been linked to barium peritonitis and colon perforation, both of which can occur as a complication of an upper gastrointestinal diagnostic radiography test. It is also a commonly experienced complication following childbirth that usually occurs within hours or days after delivery. Necrotising infections can cause the following symptoms:
- Cutaneous sensory loss
- Brawny edema
- Skin discolouration
The debridement of abdominal wall is part of the four tenets of care for necrotising infections, which are:
- Early detection
- Antibiotic therapy
- Physiological support
If all four tenets of care are combined, studies show that the mortality rates can be reduced from an almost 100% to as little as 20% when compared to treating the condition with antibiotics alone.
How is the Procedure Performed?
Following the administration of anaesthesia, the surgeon proceeds by making a transverse incision just above the umbilicus and will continue to dissect through the subcutaneous tissues in the abdomen until the fascia is reached, which is then inspected for any signs of fasciitis. With access to the contaminated tissues in the abdominal wall, the surgeon can begin the debridement procedure. All traces of oedema and necrosis are removed using sharp dissection. In the process, a certain amount of necrotic fat may be debrided.
During the procedure, the surgeon may also obtain aerobic and anaerobic cultures of the wound fluid and the subcutaneous tissue for further analysis.
The residual wound is then irrigated using a sterile saline solution and wrapped with a sterile dressing. The wound should be left covered for at least four days following the procedure. At this point, the surgeon checks to see whether the wound is clean enough to pursue closure.
The surgeon then determines whether the patient requires either delayed primary closure or secondary closure. This is decided on a case-to-case basis depending on the following factors:
- Amount of infected tissue that remains
- Patients’ nutritional status
- Other factors that may affect proper wound healing
Possible Risks and Complications
Not all debridement of abdominal wall procedures are successful. Since necrosis in the abdominal wall is a serious condition, early detection is the key to the treatment success and, in some cases, the patient’s survival. Thus, if the problem is not detected early, even an aggressive debridement may already be too late.
The risk of lethal outcomes even after an abdominal wall debridement is higher among individuals who have existing co-morbidity factors like obesity and diabetes.
Tamura Y, Nakanishi N. “A case of necrosis of the abdominal wall caused by barium peritonitis due to colon perforation following upper gastrointestinal radiography.” Journal of the Japanese Society of Intensive Care Medicine. 2016; 23(3): 341-342. https://www.jstage.jst.go.jp/article/jsicm/23/3/23341/article/references
Huljev D. “Necrotizing fasciitis of the abdominal wall with lethal outcome: A case report.” The Internet Journal of Plastic Surgery. Volume 2. http://ispub.com/IJPS/2/2/12799