Définition et aperçu

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.

Qui devrait subir et résultats attendus

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
Fièvre
Tachycardie
Hypotension
Érythème
Douleur
Décoloration de la peau

The debridement of abdominal wall is part of the four tenets of care for necrotising infections, which are:

Early detection
Debridement
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.

Comment se déroule la procédure ?

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
Diabète
Malignancy
Obésité
Other factors that may affect proper wound healing

Risques et complications possibles

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.

Les références:

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

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**Question: What⁤ is ‍Debridement of Abdominal Wall (With or Without Fascial Closure)?**

**Answer:** Debridement of the abdominal wall is a surgical procedure that involves removing infected, dead, or damaged tissue from‌ the abdomen. It aims to promote wound healing, prevent infection spread, and facilitate ‍surgical closure. The procedure can⁢ be performed with or without fascial‌ closure, depending on the severity of the wound and⁤ the patient’s condition.

**Keywords:** Debridement, Abdominal Wall, Fascial Closure, Wound Healing, Infection Control

**Question: When is Debridement of Abdominal Wall Recommended?**

**Answer:** Debridement of ⁤the abdominal wall is typically recommended in cases of:

* Severe skin infections, such as necrotizing fasciitis

* Abdominal compartment syndrome

* Trauma with extensive ⁤tissue ⁢damage

* Infected surgical wounds

*⁤ Pressure ulcers

* Debilitating conditions that impair wound healing

**Keywords:** Skin Infections, Necrotizing Fasciitis, Abdominal Compartment Syndrome, Trauma, Pressure Ulcers, Wound Healing

**Question:‌ What⁣ are the Benefits of Debridement?**

**Answer:** The⁣ benefits of debridement of the abdominal wall include:

* Removes infected or necrotic tissue, promoting wound ⁤healing

* Prevents infection spread and systemic sepsis

* Facilitates surgical closure

* Alleviates pain and discomfort

* Improves ‌cosmetic outcomes

**Keywords:** Infection Removal, Wound Healing,‌ Infection Prevention, Sepsis Prevention, Surgical Closure

**Question: What ⁤are the Expected Results of Debridement?**

**Answer:** Expected results of debridement of the abdominal wall vary depending on the severity of the wound and the patient’s overall health. Positive outcomes typically include:

*⁤ Improved wound appearance and decreased infection risk

* Reduced pain and discomfort

* Enhanced surgical closure and stabilization

* Preservation of abdominal wall integrity

* Improved surgical outcomes and overall patient well-being

**Keywords:** Improved Wound Appearance, Infection ⁣Reduction, Pain Reduction, Surgical Closure, Preservation of Abdominal Integrity

**Question: How is Debridement Performed?**

**Answer:** Debridement‍ of the abdominal wall is a surgical procedure typically performed under general anesthesia. It involves the following steps:

* Incision of the skin and exposure ⁢of the affected tissue

* Removal of infected or damaged tissue using surgical instruments (e.g., scalpels, scissors)

* Wound irrigation and debridement of the underlying fascia ⁢(in cases ⁢with fascial closure)

* Surgical closure of the wound with sutures or staples

* Application of dressings and wound management

**Keywords:** Surgical Debridement, Anesthesia, Tissue Removal, ‌Fascial Debridement, Wound Closure, Dressing Application

**Remember:** Seek professional medical advice for specific guidance on the indications, benefits, and expected results of debridement of the abdominal ⁢wall.