Assessment of Wound Dehiscence in Smead Jones (Far - Near Near - Far) Technique of Midline Abdominal Wound Closure - An Observational Study

ABSTRACT

We wanted to evaluate the occurrence of wound dehiscence in class III and class IV wounds, that are contaminated, with an interrupted, far-near near-far technique (Smead Jones technique) of midline abdominal wound closure and study the occurrence of wound dehiscence in patients requiring laparotomy having high risk / co-morbid states. MethodsA total of 100 cases was selected and abdominal wound closure was done by Smead Jones technique using polypropylene suture No. 1. The Smead Jones sutures are double loop far-near, near-far applied to linea alba. All the patients were started on intravenous antibiotics. The wound was managed by daily antiseptic dressings. Postoperatively, the patients were followed up daily for 10 days and then once every 15 days up to 6 weeks to check for any disruption in suture line. ResultsAll patients were operated under general anaesthesia. The incision used was vertical midline. Majority of the cases were perforation peritonitis and intestinal obstruction (malignant or tubercular). Out of 100 patients, 76 patients had dirty wound, 10 had contaminated and 14 patients had clean contaminated wounds. Out of 100 patients, 2 patients had wound dehiscence. Dehiscence was observed on 7th post-operative day in one patient who was a case of perforation peritonitis due to duodenal ulcer perforation, who presented late in emergency after four days of symptoms. Secondary suturing was done after proper build up and was discharged on 16th post-operative day of his index surgery. ConclusionsFrom the present study, it can be concluded that the technique of closure of contaminated and dirty wounds is an important factor in the final outcome of the emergency laparotomy. In such cases burst abdomen can be reduced using Smead Jones (far-near near-far) interrupted technique of midline abdomen wound closure using non-absorbable polypropylene suture.