Wound gape with burst abdomen

20 yr old pt referred from periphery as 11th postop day of Caesarean section with wound gape Chief Complaints Wound discharge. History Pt was operated 11 days prior in view of primi at 40 weeks with meconium stained amniotic fluid. Post op pt developed wound discharge on 6th post op day and wound gape on 9 th postop day . No history of fever. Vitals Vitals were stable Physical Examination Wound gape noted full length with slough at base and rectus sheath sloughed off. Rectus muscles visible and intestines noted in the defect between the rectus muscle however no evisceration noted. Also a track to skin noted on upper edge of wound and skin ulcer of around 5 cm above LSCS wound present. Investigations Counts 11000 N 78. Wound swab awaited Management Kindly opine on further management . Thanking you

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After stabilizing the patient with iv fluids,antibiotics, exploration of the operative wound is to be done.Dissect upto peritoneum. Suture it.Cleaning and debridement of the devitalized tissues.Sometimes release incision on rectus sheath at higher up level may help to close the defect.Close the wound in anatomical layers . Put a subcutaneous wound drain.If incisonal hernia occurs later,mesh hernioplasty may be done.But priority is to close the wound after debridement and prevent septicemia.

Thank u for ur valuable opinion
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Respected sir, would gap AND intestines noted, STILL you will wait for SWAB TEST , WBC ,THYROID TESTS, PCOD, CHOLESTEROL LEVELS to proceed your line of management, SIR ,IT IS EMERGENCY. DON'T FOR WESTERN LINE OF management/ INVESTIGATIONS.

Respected doctor...the wound is fully infected....with slough...I think....if u suture this wound without antibiotic cover ....it would lead to sepsis and generalised septicaemia...We have not sent all the test you have mentioned in your reply....I think this platform is for sharing clinical cases and getting valuable inputs...So please maintain the dignity.Thank u
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Agree with Dr Gajjar,sir what would be better for Full thickness dihisence?en mass bite or bite in layer? Please elaborate on the choice of suture material ,and type of stiches .

Thank you doctor
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