The complicated septic abdominal wound.
Since 1975, we have treated 21 patients with severe postoperative liquefaction fascial necrosis of the abdominal wall (group A, 13 patients), postoperative fascial necrosis with an associated intestinal fistula(e) within the wound (group B, three patients) and postoperative fascial necrosis with multiple internal bowel fistulae causing continuing peritoneal contamination (group C, five patients). Management in group A included general exploratory laparatomy, drainage of intra-abdominal abscesses, debridement of necrotic fascia, and loose closure of the wound with polyethylene (Marlex) mesh. Treatment in group B consisted of suture closure of exposed bowel fistulae with skin flap coverage. Group C was treated with diverting jejunostomy and suture closure of distal fistulae to avoid hazardous dissection and preserve bowel length. Overall survival was 71%.