Wound complications are important causes of early and late postoperative morbidity following laparotomy. Surgical wounds in normal, healthy individuals heal through an orderly sequence of physiologic events that include inflammation, epithelialization, fibroplasia, and maturation. Mechanical failure or failure of wound healing at the surgical site can lead to disruption of the closure leading to seroma, hematoma, wound dehiscence or hernia. Other complications include surgical site infection and nerve injury. This topic will review prevention and treatment of complications of abdominal surgical incisions.
Techniques for making and closing abdominal incisions to achieve an optimal outcome are discussed separately. (See "Principles of abdominal wall closure" and "Principles of abdominal wall incisions".)
HEMATOMA AND SEROMA
Hematoma and seroma are collections of blood and serum, respectively. Hematomas are more common than seromas, and usually result from failure of primary hemostasis or a bleeding diatheses (eg, anticoagulation). Hematomas and seromas can cause the incision to separate and predispose to wound infection since bacteria can gain access to deeper layers and multiply uninhibited in the stagnant fluid.
Clinical manifestations and diagnosis — Clinical manifestations usually appear a few days after surgery but can also be delayed. Collections of blood or serum in the wound may be asymptomatic or manifest as swelling, pain, and/or drainage. If the collection is infected, fever, erythema, wound induration and leukocytosis are also likely. (See 'Surgical site infection' below.)
The diagnosis can usually be made by inspection and palpation of the wound. If the examination is in question, ultrasound or computed tomography (CT) is useful for identifying a fluid collection, if present.