Emergency War Surgery NATO Handbook: Part IV: Regional Wounds and Injuries: Chapter XXX: Reoperative Abdominal Surgery
United States Department of Defense
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In addition to wound infection, two factors contribute to dehiscence: the failure to place retention sutures in war wounds, and the air evacuation of patients with postoperative ileus. The lowest incidence of dehiscence is achieved when the abdomen is closed with retention sutures, 2-3 cm apart, through all layers, in combination with closure of individual layers. Of the 626 casualties with abdominal wounds seen at Clark AFB, there were 26 with dehiscence (4.1%). Retention sutures had not been used in any of the 26 cases. Ileus is a factor in dehiscence because of the pressure exerted by distended bowel on the abdominal wound. Bowel gas expands by 15-30% of sea level volume at the usual cabin pressure of evacuation aircraft. The avoidance, therefore, of evacuation when ileus exists is desirable. The use of reliable nasogastric decompression minimizes this problem.
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