DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS:
Dehiscence of abdominal wound.
POSTOPERATIVE DIAGNOSIS:
Dehiscence of abdominal wound.
OPERATION PERFORMED:
Repair of dehiscence of abdominal wound.
SURGEON: John Doe, MD
ANESTHESIA:
General
COMPLICATIONS:
None.
DESCRIPTION OF OPERATION:
After appropriate consent was obtained, the patient was brought to the operating room and placed on the table in the supine position. General anesthesia was administered. The patient tolerated this well. The abdomen was prepped and draped in the usual sterile manner. The packing, which had been placed in the upper abdominal wound which was opened at bedside today to secure the diagnosis of the dehiscence, was removed. The small amount of omentum, which was in the wound was prepped along with the abdomen with Betadine scrub and paint.
After sterile prep and drape, remaining staples were removed and retractors were placed. The PDS suture in the abdomen was removed. The suture had torn through the right side of the anterior rectus fascia at multiple sites. This required mobilization of the subcutaneous tissue off the underlying fascia for further visualization of the fascia, where it appeared more healthy further back from the muscle edge, on the right side, on the superior half of the wound. After all fascial edges were well defined, a size #2 nylon retention suture was placed as a horizon mattress suture through the entire thickness of the abdominal wall, laterally from the left all the way to the lateral region on the right. Suture was brought such that it was just superficial to the peritoneum, but otherwise through all layers of the abdomen. At the end of the case, this suture was tied over a cotton bolster to provide for bolster and closure of the abdomen. The fascia was closed with multiple #1 Prolene sutures that were placed as interrupted figure-of-eight sutures. These were all placed prior to tying the sutures so that clear visualization of the fascia and adequate amounts of fascial tissue could clearly be seen and incorporated into each suture. The sutures were then tied sequentially starting at each end and holding the tension of the fascia with the next suture in sequence as sutures were tied.
Once all these sutures were tied, palpation of the midline revealed complete closure. There was no evidence of any tear of the fascia. The subcutaneous layer was irrigated and then the skin was closed with staples. A sterile dry dressing was placed. The patient was taken back to the ICU postoperatively.
