Describe options for skin closure in this case as well as management of of the wound over the next five days. The wound penetrates skin, subcutaneous fat, muscle fascia, and approximately 1 cm of muscle. Describe your evaluation and treatment of the injury. His intraoperative and postoperative course to this date have been uncomplicated. The midline abdominal wound has been dry until your exam today when you note some drainage of serosanguineous fluid from the superior aspect of the incision.
All pulses are palpable in the extremity including dorsalis pedis and posterior tibialis.
There is brawny edema and brown pigmentation noted below the knee bilaterally. Pulses are palpable in the foot. There is a weak femoral pulse present on the right side but no palpable pulses distally. Describe your management of the wound over the next several days. On the fourth post operative day there is redness and increased tenderness in the upper one third of his midline incision that was closed with staples.