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INTRODUCTION:-AWD (abdominal wound dehiscence) is a word that is widely used to describe the separation of different layers of an abdominal wound before it has healed completely. Acute laparotomy wound failure and burst abdomen are two more words that are used interchangeably. Wound dehiscence happens when a wound does not develop the necessary strength to withstand the demands exerted on it. Dehiscence happens when sutures are disrupted by external pressures, absorbable sutures dissolve too quickly, or tight sutures rip through tissues due to excessive strain. AWD has been a long-standing problem for which no surgical unit has offered a complete solution (i.e. none of the surgical units worldwide has reported 0 percent failure rate). However, numerous institutes around the world have been successful in achieving and maintaining failure rates considerably below 1%. These ?gures, on the other hand, do not deter researchers from continuing their efforts to solve the problem. In the last ten years, there have been a slew of publications attempting to explain how to solve this problem. The goal of this study is to assess the prevalence of abdominal wound dehiscence in relation to various risk factors, co-morbidities, and treatment options. The study aimed at ?nding out the AIM:- prevalence of abdominal wound dehiscence with respect to demographic factors, nature of preceding surgery and different risk factors and also to study the effective management of abdominal wound dehiscence. An Observational study METHODS:- on 60 patients comprising all patients admitted to Silchar medical College and Hospital a tertiary care center in Assam within the study period of 1st January 2021 to 31st July 2021 with diagnosed abdominal wound Dehiscence after undergoing surgical interventions. :-The majority of the patients in this study were between the ages of 41 and 50. Majority were male. RESULTS 81.67% were operated as emergency surgery. 66.67% have undergone procedures which are classi?ed as contaminated. (80%) were operated with mid line incision. 58% patients with peritonitis due to hollow viscus perforation. 58.33% had hypoalbuminemia. Malnutrition, DM, HT, pulmonary diseases, anemia etc. are important risk factors for wound dehiscence. CONCLUSION:-Because of the poor blood supply at Linea Alba, individuals who had a midline laparotomy had a higher risk of wound dehiscence than those who had a paramedian laparotomy. Wound dehiscence is more likely in people with a BMI greater than 25, compared to those with a BMI less than 25. In this study wound dehiscence is mainly associated with complications like hypoproteinemia and pulmonary complications and anaemia.
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Background: Wound dehiscence is separation of some or all layers of incision. It may be partial or complete. It is called as complete when all layers of the abdominal wall have been separated with or without evisceration of viscous. The study aims to find out and record the prognostic factors for wound dehiscence in vertical midline laparotomy.Methods: This was a prospective study in 1400 laparotomies that developed wound dehiscence operated in Gandhi Medical College, Bhopal from august 2017 to august 2019. All the patients with burst abdomen operated during emergency or elective setting by midline vertical laparotomy were included.Results: Wound dehiscence was most common in 51-60 years age group (26%). Majority patients were males (62%). Emergency laparotomy showed maximum incidence (71%). Bursts were seen mostly during 6th to 10th postoperative day. 78% patients presented as partial wound dehiscence and remaining as complete wound dehiscence. 46% presented as early wound dehiscence (7 days).Conclusions: Post laparotomy wound dehiscence has multifactor etiology. Respiratory infections, anemia, and hypoproteinaemia are the contributing factors. Improper haemostasis during surgery and poor surgical technique are the predisposing factors.
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Background: Relaparotomy after emergency surgery is a catastrophic situation associated with significant morbidity and mortality. Incidence is highly variable depending not only on hospital set up but also on the patient’s characteristics as well as on the initial surgery and postoperative care given. This study was thus, planned to identify the indications, procedure, risk factors and outcomes of relaparotomy so that timely intervention can lower incidence and morbidity.Methods: This was a retrospective cohort study conducted in department of general surgery, Gandhi Medical College and associated Hamidia Hospital from January 2018 to December 2019. All patients irrespective of age and sex, who have undergone emergency re-exploration of the abdomen during the period of hospitalization after the first operation and discharge of patients. Data were recorded in pre-validated case record form.Results: 32 cases of relaparotomy were identified. All patients had emergency laparotomy as primary surgery. Majority of patients required relaparotomy for anastomotic site leak in 16 cases (50%) followed by intestinal obstruction in 10 cases (31%), hemorrhage in 4 cases (16%) while the least cause being intra-abdominal sepsis in 2 cases (6.2%). Relaparotomy was associated with increased mortality and morbidity. Out of 32 patients, 4 (12.5%) patients died.Conclusions: Relaparotomy is a rare complication and a lifesaving procedure for patients. Calculative experience guided decision on relaparotomy can decrease the incidence of morbidity and mortality associated with the procedure.
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Background: Abdominal wound dehiscence is a commoncomplication of emergency laparotomy. Its prevention inimportant to reduce postoperative morbidity and mortality. Theaim of this study to compare the incidence and risk of burstabdomen, wound infection and sinus formation withPolydiaxanone (PDS II) versus Polypropylene (PPL) in midlinelaparotomy wounds.Materials and Methods: 60 patients undergoing laparotomythrough a midline vertical incision were randomized afterinformed consent, to either a Polydiaxanone (PDS II) versusPolypropylene (PPL) suture material. The incidence andrelative risk (RR) of burst abdomen, wound infection and sinusformation using Polypropylene (PPL) group as the referencecategory were calculated.Results: There was 1 burst abdomen (out of 30 cases, 3.3%)in Polypropylene (PPL) group and none (out of 30) inPolydiaxanone (PDS II). The RR of burst could not becalculated because of 0 in one arm. The incidence of woundinfection was 16.6% in Polypropylene (PPL) (5 out of 30 cases)compared to 10% (3 out of 30 cases) in Polydiaxanone (PDSII). The relative risk (RR) of wound infection was 0.60. Theincidence of suture sinus was 10% (3 out of 30 cases) inPolypropylene (PPL) as compared to 3.3% in Polydiaxanone(PDSII) group.Conclusion: The risk of burst abdomen, wound infection &suture sinuses is less with the use of Polydiaxanone (PDS II).
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Despite the advances made in asepsis, antimicrobial drugs, sterilization and operative technique, post-operative wound problems continue to be a major threat. Clean sound healing of laparotomy wound after any intra-abdominal procedure is a cardinal index of good surgical repair. Post- operative wound problems delays recovery and often increase stay and may produce lasting sequel and require extra resources for investigations, management and nursing care, therefore its prevention is relevant to quality patient care, therefore its prevention is relevant to quality patient care.Post-operative wound problems seldom causes death, yet it does prove to be an economic burden on patient and on health system and induce psychological trauma to the surgeon as it robs his hours of dedicated work on operating table and good carrier. Considering wound problems is quite common in developing countries like India the present study was taken up to find out the incidence of Post-operative wound problems and factors that influence its occurrence. Present study aimed to discover the sound, ideal method for the abdominal wound closure with regard to the problems associated with laparotomy wound.
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Background: There are no accepted guidelines for the closure of laparotomy incisions in patients of peritonitis. As these patients differ from the patients undergoing elective abdominal surgery, the same recommendations for closure may not be applicable in both groups. Aim: To compare wound outcome parameters following closure of the laparotomy incision with absorbable and non-absorbable suture material using the continuous and interrupted techniques in patients of peritonitis. Method: A single blinded randomised controlled trial using Polygalactin–910 and Polypropylene, number 1 sutures, to close midline vertical incisions, placed in continuous and interrupted manner, was performed on 174 patients. Patients were randomised into four groups: Group A (Polygalactin-910 continuous suturing, n=40), B (Polygalactin-910 interrupted suturing, n=47), C (Polypropylene continuous suturing, n=45) and D (Polypropylene interrupted suturing, n=42). The incidence of wound infection, dehiscence, suture sinus formation and incisional hernia was recorded. Patients were followed up for a period of four years. Statistical analysis involved the chi-square and Fisher’s exact tests. A ‘p’ value of <0.05 was considered significant. Results: The study included 139 male and 35 female patients between the ages of 10 and 75 years. The incidence of wound infection (p=0.656), dehiscence (p=0.997), and incisional hernia (p=0.930) at 3 months and four years (p= 0.910) was not statistically significant. There was no sinus formation in groups A and B, however 2 patients of group C and 6 patients of group D did develop suture sinus (p=0.003). Conclusion: Suture material and technique of closure does not influence wound outcome in patients of peritonitis except for a significantly lower incidence of sinus formation when non-absorbable sutures are used.