Skin closure in laparotomy; delayed versus primary closure performed for generalized peritonitis

The aim of this study was to record the outcome of healing in laparotomy wounds, managed by delayed versus primary skin closure in terms of hospital stay, major and minor wound infection. Quasi experimental study from September, 2006 to March, 2007. Surgical floor of Allied Hospital, [Punjab Medical College] Faisalabad. Detailed data of each patient including presentation, operative findings, procedure performed, post operative outcome was entered on a specially designed proforma. The main outcome measures found significant were major and minor wound infection, time of presentation and advancing age and hospital stay. Sixty patients underwent exploratory laparotomy through vertical abdominal incision during Sep.2006 to Mar.2007. Skin wound of the first thirty patients [group A] were left open and closed on 4th day while that of next thirty patients [group B] closed primarily. Out of sixty patients ten patients developed major wound infection leading to wound dehiscence [16.66%]. Four belonged to group A [13.33%] and six belonged to group B[20%] [p<0.05]. In advancing age the infection rate was significantly high in the same group [p<0.01]. Regarding hospital stay of patients of two groups the difference was statistically significant. Group A [mean=7.77, std. dev=2.029 and std. error of mean=0.370]. Group B [mean=10.30, std. dev=4.822 and std. error of mean=0.880]. Regarding age the difference was not statistically significant between two groups. Group A [mean 30.47, std. dev=10.099 and std error of mean=1.844]. The data was analyzed using SPSS 17 Chi-square test was used to test the significance between qualitative variable, p<0.05 was considered significance. No matter how advanced new wound closure techniques are, wound infection is the single most important factor for wound dehiscence and it can be decreased by using delayed skin closure technique and meticulous post-operative monitoring and care

Circumcision: complications associated with the plastibell device and conventional dissection surgery: a trial of 200 neonates

To evaluate two methods of circumcision in terms of the incidence of complications in neonates and operative time required for these two procedures. Comparative study. At private hospital.Duration:2 years between 2007-2009. 200 neonates equal to or less than 04weeks of age were included in the study. They were randomly divided for one of the two techniques and complications between the two groups were assessed along with time period required for these two procedures. The overall rates of complications in CDS and PD groups were 8% and 3.0%, respectively. The p value for all the qualitative variables was more>0.5.which is insignificant. It shows that there is no significant difference in terms of frequency of complications in both groups. The average procedure time for PD and CDS methods was between 4-7 minutes and 15-22 minutes respectively and for this quantitative variable .p value was 0.0005.This shows a significant difference in operating time between the two procedures. The results of this study suggest the PD method is a safe and rapid procedure as compared to CDS for neonates

Patterns of presentation, surgical management and outcome of patients with degloving injures

To describe the patterns of degloving injuries and to identify the outcome of different management techniques in patients with degloving injuries in patients presenting at Allied and Divisional headquarters hospital, Faisalabad. Prospective case study from January, 2008 to July 2008. Surgical floor of Allied and District Headquarters [Teaching] Hospitals, Faisalabad. Detailed data of each patient including presentation, operative findings, procedure performed, post operative outcome was entered on a specially designed Proforma, compiled and analyzed by using SPSS. Between February 2008 and July 2008, a total of 50 patients were included in the study. The etiological factors were road traffic accidents in 78% [39 patients], rotatory machine accidents 16% [8 patients] and domestic trauma in the remaining 6% [3 patients]. Degloving injury more commonly occurred in the lower limb 44% [22 patients], upper limb 16% [8 patients], scalp 22% [11 patients], penoscrotal 10% [5 patients] and miscellaneous group 8% [4 patient]. Associated skeletal fracture was seen in 3 [6%] patients. With increasing road traffic accidents, there is a marked increase in patients presenting to emergency department with degloving injuries. Early recognition and well planned surgical approach is all it takes to prevent complications and salvage a limb