Vacuum-Assisted Wound Closure Achieves Early Fascial Closure of Open Abdomens after Severe Trauma

The purpose of this study was to determine the incidence of wound dehiscence after repeat trauma laparotomy. We performed a retrospective analysis of adult trauma patients who underwent laparotomy at an urban level 1 trauma center during the past 5 years. Patients were divided into single (SL) and multiple laparotomy (ML) groups. Demographic, clinical, and outcome data were collected. Data were analyzed using χ2, t testing, and ANOVA. Overall dehiscence rate was 0.7 per cent. Multiple laparotomy patients had damage control, staged management of their injuries, or abdominal compartment syndrome as the reason for reexploration. SL and ML patients had similar age and sex. ML patients had a higher rate of intra-abdominal abscess than SL patients (13.7% vs 1.2% P < 0.0001), but intra-abdominal abscess did not predict wound dehiscence in the ML group ( P = 0.24). This was true in spite of the fact that ML patients had a significantly higher Injury Severity Score (ISS) than SL patients (21.68 vs 14.35, P < 0.0001). Interestingly, wound infection did not predict dehiscence. Patients undergoing repeat laparotomy after trauma are at increased risk for wound dehiscence. This risk appears to be associated with intraabdominal abscess and ISS, but not wound infection. Surgeons should leave the skin open in the setting of repeat trauma laparotomy, which will allow serial assessment of the integrity of the fascial closure.

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A clinical study of continuous and interrupted fascial closure in emergency midline laparotomy at a tertiary care centre

International Surgery Journal ◽

10.18203/2349-2902.isj20172403 ◽

2017 ◽

Vol 4 (6) ◽

pp. 2014

Author(s):

Rahul D. Kunju ◽

Vinayak Thakkannavar ◽

Shrivathsa Merta K. ◽

Sachin H. G. ◽

Allen Netto ◽

...

Keyword(s):

Incisional Hernia ◽

Wound Infection ◽

Wound Closure ◽

Tertiary Care ◽

Fascial Closure ◽

Emergency Laparotomy ◽

Closure Technique ◽

Burst Abdomen ◽

Midline Laparotomy ◽

Laparotomy Wound

Background: Commonest approach in emergency open abdominal surgeries remains to be midline laparotomy because it is simple, saves time and causes minimal blood loss. Optimal technique for laparotomy wound closure has been a topic of debate since long. Risk factors for development of incisional hernia and burst abdomen are wound infection, systemic illnesses of patient and closure technique. Factors related to patients like age, gender, body mass index (BMI), systemic illnesses are not modifiable when an emergency laparotomy is the only option. Hence closure technique is one factor where surgeon has total control, which can bring down the incidence of burst abdomen and incisional hernias.Methods: Prospective study conducted in 150 patients who underwent emergency midline laparotomy from December 2014 to February 2016 in Krishna Rajendra Hospital attached to Mysore Medical College and Research Institute, Mysore, Karnataka, India with 6 months’ follow-up after surgery.Results: Most of patients in the study belonged to 30-40-year group and were males (78%). Gastrointestinal perforation peritonitis (52%) was the single most common indication for emergency midline laparotomy. In the continuous and interrupted groups, post-operative wound infection was found in 54.6% and 34.6%, wound dehiscence was found in 16% and 6.6% and incisional hernia in 14.4% and 4% respectively.Conclusions: Interrupted suturing is superior to continuous technique in emergency midline laparotomy wound closure in terms of complications and post-operative morbidity.

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Evaluation of abdominal wound closure using continuous versus interrupted sutures in patients of perforation peritonitis

International Surgery Journal ◽

10.18203/2349-2902.isj20210914 ◽

2021 ◽

Vol 8 (3) ◽

pp. 844

Author(s):

Arnab Mohanty ◽

Yoel Dewa Paljor ◽

Rajeev Sharma

Keyword(s):

Wound Closure ◽

Critical Role ◽

Wound Dehiscence ◽

Fascial Closure ◽

New Delhi ◽

Abdominal Wound ◽

Hollow Viscus ◽

Single Centre Study ◽

Perforation Peritonitis ◽

Group B

Background: The type of wound closure plays a critical role in patients of perforation peritonitis, since many of these patients also have poorly controlled co-morbidities and risk factors for wound dehiscence. Though many studies have evaluated abdominal wound closures in the elective scenario, similar studies in the emergent scenario are rather scarce. Hence, we have dealt with this issue in patients presenting with hollow viscus perforation peritonitis.Methods: This was a prospective randomized case control single-centre study with 120 patients performed at St. Stephen’s Hospital, New Delhi, India between February 2016 and January 2019. These patients were randomized divided into two groups; group A comprising those patients in whom, the abdominal wound was closed with continuous sutures, and group B comprising those in whom it was closed with interrupted sutures. Informed consent was taken from all the patients. A detailed proforma included all parameters. Follow up was conducted at 2, 4, 6 and 12 weeks from the date of surgery. Data analysis was done using S.P.S.S. version 17.Results: The time taken for continuous suture fascial closure was significantly less than the interrupted technique. There were no significant differences in other parameters, immediately or on follow-up.Conclusions: The continuous method of abdominal closure was faster than interrupted suturing on account of the use of only two terminal knots, this difference being statistically significant. The outcomes were comparable to other studies that have dealt with this issue in elective surgeries.

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Suture-Tool: A Mechanical Needle Driver for Standardized Wound Closure

World Journal of Surgery ◽

10.1007/s00268-019-05179-5 ◽

2019 ◽

Vol 44 (1) ◽

pp. 95-99

Author(s):

Gabriel Börner ◽

Agneta Montgomery

Keyword(s):

Medical Technology ◽

Wound Closure ◽

Suture Line ◽

Fascial Closure ◽

High Quality ◽

Burst Abdomen ◽

Incision Length ◽

Needle Driver ◽

Mechanical Suture ◽

Suture Device

Abstract Introduction A laparotomy is commonly required to gain abdominal access. A safe standardized access and closure technique is warranted to minimize abdominal wall complications like wound infections, burst abdomen and incisional hernias. Stitches are recommended to be small and placed tightly, obtaining a suture length-to-incision length (SL/WL) ratio of ≥ 4:1. This can be time-consuming and difficult to achieve especially following long trying surgical procedures. The aim was to develop and evaluate a new mechanical suture device for standardized wound closure. Methods A mechanical suture device (Suture-tool) was developed in collaboration between a medical technology engineer team with the aim to achieve a standardized suture line of high quality that could be performed speedy and safe. Ten surgeons closed an incision in an animal tissue model after a standardized introduction of the instrument comparing the device to conventional needle driver suturing (NDS) using the 4:1 technique. Outcome measures were SL/WL ratio, number of stitches and suture time. Results In total, 80 suture lines were evaluated. SL/WL ratio of ≥ 4 was achieved in 95% using the Suture-tool and 30% using NDS (p < 0,001). Number of stitches was similar. Suture time was 30% shorter using the Suture-tool compared to NDS (2 min 54 s vs. 4 min 5 s; p < 0.001). Conclusions The mechanical needle driver seems to be a promising device to perform a speedy standardized high-quality suture line for fascial closure.

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Dynamic Fascial Closure With Vacuum-Assisted Wound Closure and Mesh-Mediated Fascial Traction (VAWCM) Treatment of the Open Abdomen—An Updated Systematic Review

Frontiers in Surgery ◽

10.3389/fsurg.2020.577104 ◽

2020 ◽

Vol 7 ◽

Author(s):

Patrik Petersson ◽

Ulf Petersson

Keyword(s):

Systematic Review ◽

Wound Closure ◽

Open Abdomen ◽

Fascial Closure

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Comparison of non-absorbable (polypropylene) versus delayed absorbable (polydioxanone) suture material for abdominal wound closure after laparotomy

International Surgery Journal ◽

10.18203/2349-2902.isj20181404 ◽

2018 ◽

Vol 5 (5) ◽

pp. 1690 ◽

Cited By ~ 1

Author(s):

Deepti Pai ◽

Rajgopal Shenoy ◽

Chethan K.

Keyword(s):

Surgical Site Infection ◽

Wound Closure ◽

Suture Material ◽

Fascial Closure ◽

Abdominal Wound ◽

Site Infection ◽

Suture Materials ◽

Significant Difference ◽

Operative Complications ◽

Post Operative Complications

Background: Type of suture material used for fascial closure in laparotomies influences the incidence of post-operative complications. Currently there is no consensus on the superiority of either absorbable or non-absorbable suture materials for abdominal fascial closure. Aim of this study was to determine the superior suture material for abdominal wall closure after elective laparotomy among polypropylene and polydioxanone based on the occurrence of specific post-operative complications.Methods: A prospective observational study was conducted at Kasturba hospital, Manipal from September 2014 to August 2016. Patients admitted under General surgery, who underwent midline laparotomy were included in the study. Polydioxanone and Polypropylene suture materials were used for mass closure and post-operative complications were compared.Results: Hundred patients were included. The two study groups (Prolene and Polydioxanone) were homogenous, with no significant difference between age, BMI, co-morbidities and indication for surgery. Surgical site infection was significantly more in prolene group (p=0.031). Duration of surgeries was longer in prolene group (p=0.020), hence, a subgroup analysis was done and only surgeries under 4-hour duration were analysed. It showed no difference between the two groups with respect to surgical site infection (p=0.320). There was no significant difference between the two groups in burst abdomen and incisional hernia.Conclusions: There was no significant difference between Prolene and Polydioxanone when early and late post-operative complications were compared. Hence, either of the two suture materials can be used for abdominal wound closure in elective midline laparotomies.

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Vacuum-Assisted Wound Closure and Permanent Onlay Mesh–Mediated Fascial Traction: A Novel Technique for the Prevention of Incisional Hernia after Open Abdomen Therapy Including Results From a Retrospective Case Series

Scandinavian Journal of Surgery ◽

10.1177/1457496918818979 ◽

2018 ◽

Vol 108 (3) ◽

pp. 216-226 ◽

Cited By ~ 7

Author(s):

P. Petersson ◽

A. Montgomery ◽

U. Petersson

Keyword(s):

Incisional Hernia ◽

Wound Closure ◽

Open Abdomen ◽

Case Series ◽

Fascial Closure ◽

Short Term ◽

Retrospective Case ◽

Patient Reported ◽

Onlay Mesh

Background and Aims: Incisional hernia development is a frequent long-term sequel after open abdomen treatment. This report describes a novel technique, the vacuum-assisted wound closure and permanent onlay mesh–mediated fascial traction for temporary and final closure of the open abdomen, with the intention to decrease incisional hernia rates. Primary aim was to evaluate incisional hernia development and secondary aims to describe short-term complications and patient-reported outcome. Materials and Methods: The basics of the technique is an onlay mesh, applied early during open abdomen treatment by suturing to the fascia in two rows with a 3- to 4-cm overlap from the midline incision, used for traction and kept for reinforced permanent closure. A retrospective case series, including chart review, evaluation of computed tomography/ultrasound images, and an out-patient clinical examination were performed. The patients were asked to answer a modified version of the ventral hernia pain questionnaire. Results: A total of 11 patients were treated with vacuum-assisted wound closure and permanent onlay mesh–mediated fascial traction with median follow-up of 467 days. Fascial closure rate was 100% and 30 day mortality 0%. Two of nine patients, eligible for incisional hernia follow-up, developed a hernia. Neither of the hernias were symptomatic nor clinically detectable. Six of 10 patients eligible for short-term follow-up had a prolonged wound-healing time exceeding 3 weeks. One of seven patients eligible for patient-reported outcome have had pain during the last week. Conclusion: The vacuum-assisted wound closure and permanent onlay mesh–mediated fascial traction is a promising new technique for open abdomen treatment and reinforced fascial closure. The results of the first 11 patients treated with this technique show a low incisional hernia rate with manageable short-term wound complications and few patient-reported disadvantages.

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