PMC4005143_01
Abdominal examination on presentation to the tertiary care center on postoperative day 12.
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Her wound cellulitis continued to progress with evidence of hemorrhagic skin bullae with surrounding necrosis and crepitus (Figure 1).
Intra-operative uterus examination demonstrating good vascularity on postoperative day number 12.
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Good perfusion of the uterus (confirmed by noting active bleeding after incision into the anterior serosa and myometrium) and adnexa was appreciated (Figure 2).
Post-operative uterus examination demonstratingextensive necrosis of the myometrium with acute inflammation, extending from the lower uterine segment to the uterine fundus.
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A total abdominal hysterectomy was therefore performed with pathology revealing extensive necrosis of the myometrium with acute inflammation, extending from the lower uterine segment to the uterine fundus (Figure 3).
Depicts complete resection of the rectus abdominal muscles and fascia:20 x 25 cm open anterior abdominal defect on postoperative day number 20.
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During each visit to the operating room, extensive debridement of her anterior abdominal wall was performed; however, during her 8th visit, postcesarean day 20, even more extensive debridement was undertaken to 2 cm beyond the bleeding edges to insure adequate resection (Figure 4). A 20 x 25 cm open anterior abdominal defect with no rectus abdominal muscles or fascia remained (Figure 4).
Multiple reconstructive surgeries have resulted in complete closure of her anterior abdominal wall.
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Over the next 3 months, her abdominal wall defect had successfully completely granulated and she underwent 2 additional reconstructive surgeries to close her abdominal wall defect (Figure 5).