Extensive adipose tissue necrosis with pressure necrosis following Pfannenstiel incision: A complication of infected parietal wound hematoma

Publication date: Available online 18 April 2016 Source:Apollo Medicine Author(s): Ahmed S. El-Agwany Hematomas are postoperative complications that may arise from Pfannenstiel incisions. They usually resolve spontaneously or drained according to their extent. Obesity and diabetes may lead to infection and worsen the outcome. A 30-year-old woman presented with a large parietal wall hematoma 10 days after hysterotomy through a Pfannenstiel incision for missed abortion with bleeding placenta previa. The hematoma progressed, became infected and let to extensive subcutaneous fat necrosis with pressure necrosis that drained infected non-clotted altered blood through the main incision and another one as well. Extensive debridement was required, and packing with gauze was used to allow second intention closure. Satisfactory healing was achieved after 3 months of treatment without skin grafting. This case highlights the need for strict hemostasis with limited dissection of the upper flap of the rectus sheath and usage of broad-spectrum antibiotics, especially in obese and diabetic patients.
Source: Apollo Medicine - Category: Journals (General) Source Type: research