Management of Laparotomy Wound Dehiscence

2007 ◽  
Vol 73 (12) ◽  
pp. 1224-1227 ◽  
Author(s):  
Daniel E. Abbott ◽  
Gregory A. Dumanian ◽  
Amy L. Halverson
Keyword(s):  
Primary Closure ◽  
Abdominal Wall Defect ◽  
Wound Dehiscence ◽  
High Rate ◽  
Fascial Closure ◽  
Wall Defect ◽  
Laparotomy Wound ◽  
Abdominal Wound Dehiscence ◽  
Successful Repair ◽  
Optimal Treatment Strategy

Many studies identify risk factors for dehiscence, but a paucity of data exist suggesting an optimal treatment strategy. This study examines repair of abdominal wound dehiscence, comparing closure and interposition of mesh. We conducted a retrospective review of 37 individuals who suffered a wound dehiscence after laparotomy. Outcomes of repairs with either primary closure or polyglactin mesh interposition were examined. Twenty-seven individuals underwent repair with primary closure. Twelve of these individuals suffered repeat wound dehiscence; 10 were treated with repeat fascial closure, 2 with polyglactin mesh interposition. Seven individuals initially underwent successful repair with polyglactin mesh interposition; all subsequently had their hernias repaired. Three patients had minor fascial separation managed nonoperatively. Primary closure is associated with a relatively high rate of recurrent wound dehiscence. Closure with polyglactin mesh interposition has a higher initial success rate, but necessitates additional surgeries for repair of the abdominal wall defect.

scholarly journals Successful management of abdominal wound dehiscence using a vacuum assisted closure system combined with mesh-mediated medial traction

2015 ◽  
Vol 97 (1) ◽  
pp. e3-e5 ◽  
Author(s):  
AC Lord ◽  
R Hompes ◽  
A Venkatasubramaniam ◽  
S Arnold
Keyword(s):  
Abdominal Wall ◽  
Primary Closure ◽  
Open Abdomen ◽  
Wound Dehiscence ◽  
Fascial Closure ◽  
Abdominal Wound ◽  
Closure System ◽  
Vacuum Assisted Closure ◽  
Successful Management ◽  
Abdominal Wound Dehiscence

Management of the open abdomen has advanced significantly in recent years with the increasing use of vacuum assisted closure (VAC) techniques leading to increased rates of fascial closure. We present the case of a patient who suffered two complete abdominal wall dehiscences after an elective laparotomy, meaning primary closure was no longer possible. She was treated successfully with a VAC system combined with continuous medial traction using a Prolene®mesh. This technique has not been described before in the management of patients following wound dehiscence.

Damage Control Laparotomy Wound Incisions Can Be Closed With Low Rates of Superficial Surgical Site Infections

2021 ◽  
pp. 000313482110545
Author(s):  
John D. Cull ◽  
Kristen A. Spoor ◽  
Katherine F. Pellizzeri ◽  
Benjamin M. Manning
Keyword(s):  
Retrospective Review ◽  
Primary Closure ◽  
Damage Control ◽  
Surgical Site Infections ◽  
Fascial Closure ◽  
Damage Control Laparotomy ◽  
Secondary Intention ◽  
Delayed Primary Closure ◽  
Laparotomy Wound

Due to high rates of surgical site infections (SSIs) in damage control laparotomies (DCLs), many surgeons leave wounds to heal by secondary intention. We hypothesize that patients after DCL can have their wounds primarily closed with wicks/Penrose drains with low rates of superficial surgical site infections. A retrospective review of a prospectively maintained DCL database was performed for all patients who underwent DCL from January 2016 to June 2018. From January 2016 to June 2018, a total of 171 patients underwent DCL. After exclusions, 107 patients were reviewed to assess for SSI. 57 patients were closed with wicks/Penrose drains, 3 were closed with delayed primary closure, and 47 patients were closed completely at time of fascial closure. There were 4 (3.7%) superficial SSIs, 13 (12.1%) organ space infections, and 14 surgical site occurrences (3 of which required opening the skin). Primary closure of incisions after DCL has low superficial SSI rates.

scholarly journals Cloacal Exstrophy Repair with Primary Closure of Bladder Exstrophy: A Case Report and Review of Literature

2016 ◽  
Vol 2016 ◽  
pp. 1-3 ◽  
Author(s):  
George Bethell ◽  
Navroop Johal ◽  
Peter Cuckow
Keyword(s):  
Case Report ◽  
Primary Closure ◽  
Abdominal Wall Defect ◽  
Bladder Exstrophy ◽  
Inpatient Stay ◽  
Review Of Literature ◽  
Cloacal Exstrophy ◽  
Wall Defect ◽  
Staged Approach ◽  
Reduced Risk

Cloacal exstrophy is the most complex congenital, ventral, abdominal wall defect. Traditionally surgery consists of a staged approach to repair which takes place on many separate theatre visits. In this case a primary approach was undertaken resulting in a relatively short inpatient stay and a reduced risk from multiple surgical procedures under general anaesthesia.

scholarly journals Laparoscopic fundoplication for a case of esophageal hiatal hernia after gastroschisis repair

2019 ◽  
Vol 5 (1) ◽  
Author(s):  
Ryuichiro Hirose ◽  
Satoshi Obata ◽  
Manabu Tojigamori ◽  
Masatoshi Nakamura ◽  
Shohei Taguchi ◽  
...  
Keyword(s):  
Gastroesophageal Reflux ◽  
Hiatal Hernia ◽  
Laparoscopic Fundoplication ◽  
Abdominal Wall Defect ◽  
Male Infant ◽  
Fascial Closure ◽  
Wall Defect ◽  
Esophageal Hiatal Hernia ◽  
Frequent Vomiting ◽  
Laparoscopic Nissen

Abstract Background Esophageal hiatal hernia and gastroesophageal reflux have been recognized as inevitable complications after the definitive gastroschisis operation. Patients with refractory gastroesophageal reflux require anti-reflux surgery; however, the surgical adhesions may complicate subsequent surgical therapy, especially in the cases treated by staged repair. Case presentation A male infant who showed a severe gastroesophageal reflux due to hiatal hernia after staged abdominal fascial closure of gastroschisis. In spite of continuous conservative management, frequent vomiting and hematemesis had become progressively worse at the age of 8 months. Laparoscopic Nissen fundoplication was attempted and completed with no adverse events. Conclusions Laparoscopic fundoplication may be applied, as a first-line approach, for the treatment of gastroesophageal reflux in this difficult group of patients, after the repair of congenital abdominal wall defect.

Closed Gastroschisis: A Rare Abdominal Wall Defect

2021 ◽  
pp. 000313482110298
Author(s):  
Hannah Cockrell ◽  
Taylor Shaw ◽  
Michael W. Morris
Keyword(s):  
Prenatal Diagnosis ◽  
Abdominal Wall ◽  
Abdominal Wall Defect ◽  
Intestinal Atresia ◽  
Bowel Ischemia ◽  
Fascial Closure ◽  
Fascial Defect ◽  
Wall Defect ◽  
Emergent Operation ◽  
The Right

Gastroschisis is a rare congenital abdominal wall defect characterized by intestinal evisceration to the right of the umbilical stalk. In less than 6% of cases, the fascial defect closes around the herniated viscera in utero. The mechanism of fascial closure in these cases is unknown; however, the tourniquet effect on the mesenteric vasculature is thought to lead to intestinal atresia and midgut infarction. We report a case of a female neonate with a prenatal diagnosis of gastroschisis who was found to have a closed defect at the time of delivery. She required emergent operation for symptoms of intestinal obstruction and bowel ischemia.

scholarly journals Study of negative pressure wound therapy in management of abdominal wound dehiscence

2020 ◽  
Vol 7 (7) ◽  
pp. 2195
Author(s):  
Bhupesh Tirpude ◽  
Mrinalini M. Borkar ◽  
Nilesh N. Lokhande
Keyword(s):  
Hospital Stay ◽  
Negative Pressure ◽  
Negative Pressure Wound Therapy ◽  
Wound Dehiscence ◽  
Wound Contraction ◽  
Fascial Closure ◽  
Abdominal Wound ◽  
Wound Therapy ◽  
Wound Sepsis ◽  
Abdominal Wound Dehiscence

Background: Postlaparotomy Abdominal wound dehiscence (AWD) occurs in 0.25% to3%. Many technique are being used to manage AWD like surgical revision with open dressing/closed irrigation, temporary covering with ‘Bagota bag’, saline soak gause dressing, absorbable/permanent mesh. Negative-pressure wound therapy (NPWT) is a recent modality of treatment of wound. It involves controlled application of sub atmospheric pressure to local wound environment, using sealed wound dressing connected to vacuum pump. This study aimed at finding the effectiveness of negative pressure wound therapy in management of abdominal wound dehiscence over conventional methods of wound management.Methods: This was hospital based non randomised comparative prospective interventional study carried between July 2017 to November 2019, includes all patients admitted in GMCH, Nagpur Hospital having post laparotomy AWD, excluding the patients having enter ocutaneous fistula and patient not giving consent for VAC application. Total n=60 cases were included in study. Out of 60, 30 were taken as cases in whom intervention was done by applying vaccum assisted closure (VAC) therapy and 30 were control.Results: All 60 patients had undergone laparotomy of this patients 30 patients was applied NPWT and efficacy plotted on the parameter of, wound sepsis, wound contraction, length of hospital stay and extension of time therapy. It was found that 90% patients had negative c/s post VAC dressing, compared to 26% in post ns dressing, there was MWC of 0.86 cm in post VAC patients compared to 0.14 cm in post NS dressing, MHS was 18.9 days in cases and was 28 days in controls,13 patients had complete fascial closure in cases whereas none in controls.Conclusions: NPWT significantly reduces the hospital stay of patients, it causes faster and higher degree of wound contraction, reduces wound sepsis thereby reducing morbidity of patients.

scholarly journals Reverse Tissue Expansion in Gastroschisis: What to do if the Defect is too large to close after Silo Removal?

2014 ◽  
Vol 3 (4) ◽  
Author(s):  
Boma T Adikibi ◽  
Stuart O'Toole
Keyword(s):  
Abdominal Wall Defect ◽  
Good Condition ◽  
Tissue Expansion ◽  
Fascial Closure ◽  
Skin Closure ◽  
Progressive Reduction ◽  
Purse String ◽  
Wall Defect ◽  
Female Baby ◽  
Successful Reduction

A female baby with an antenatal diagnosis of gastroschisis was transferred to our institution. The defect was large but the bowel was in good condition and a silo was placed. After successful reduction of the bowel the abdominal wall defect was too large to allow fascial or even skin closure. We utilised a Gore-tex patch with two prolene purse string sutures placed concentrically to enable the diameter of the patch to be sequentially reduced. This enabled gradual stretching of the tissues with a progressive reduction in the size of the defect. The patch was removed after 8 days and a delayed fascial closure was achieved.

scholarly journals Comparative study of abdominal wound dehiscence in continuous versus interrupted fascial closure after emergency midline laparotomy

2019 ◽  
Vol 6 (3) ◽  
pp. 886
Author(s):  
Rajesh Kumar Bansiwal ◽  
Tarun Mittal ◽  
Rajeev Sharma ◽  
Sanjay Gupta ◽  
Simrandeep Singh ◽  
...  
Keyword(s):  
Rectus Sheath ◽  
Wound Dehiscence ◽  
Fascial Closure ◽  
Emergency Laparotomy ◽  
Abdominal Wound ◽  
Midline Laparotomy ◽  
Medical College ◽  
Group A ◽  
Abdominal Wound Dehiscence ◽  
Group B

Background: Laparotomy wound dehiscence is still a puzzle for most of the surgeons. Mortality associated with dehiscence has been estimated at 10-30%. Patients undergoing emergency laparotomy suffer from one of these comorbid conditions which are detrimental to healing. In this scenario interrupted suturing has been found to give good strength and have less incidence of wound dehiscence. The objective of the study was to compare the incidence of abdominal wound dehiscence in emergency midline laparotomy.Methods: This study was conducted on 300 consecutive patients undergoing emergency midline laparotomy in the Department of Surgery, Government Medical College and Hospital. Methods group-A: closed by suturing the rectus sheath using polydioxanone suture 1-0 (PDS) in continuous layer suturing method. group-B: closed by suturing the rectus sheath using polydioxanone suture 1-0 in interrupted layer suturing method.Results: The mean age in group A was 40.47 years and 37.47 in group B. In Group A 20.1% patients had burst abdomen and 5.4% in group B.Conclusions: Interrupted closure of abdominal wall fascia is better in emergency laparotomy as compared to continuous closure.

Clinical outcome of V-Y flap with latissimus dorsi and gluteal advancement for treatment of large thoracolumbar myelomeningocele defects: a comparative study

2019 ◽  
Vol 24 (1) ◽  
pp. 75-84
Author(s):  
Mohammad Sadegh Masoudi ◽  
Mohammad Ali Hoghoughi ◽  
Fariborz Ghaffarpasand ◽  
Shekoofeh Yaghmaei ◽  
Maryam Azadegan ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Comparative Study ◽  
Surgical Site Infection ◽  
Latissimus Dorsi ◽  
Primary Closure ◽  
Wound Dehiscence ◽  
Site Infection ◽  
Gluteal Muscle ◽  
Operative Duration ◽  
Csf Leakage

OBJECTIVESurgical repair and closure of myelomeningocele (MMC) defects are important and vital, as the mortality rate is as high as 65%–70% in untreated patients. Closure of large MMC defects is challenging for pediatric neurosurgeons and plastic surgeons. The aim of the current study is to report the operative characteristics and outcome of a series of Iranian patients with large MMC defects utilizing the V-Y flap and with latissimus dorsi or gluteal muscle advancement.METHODSThis comparative study was conducted during a 4-year period from September 2013 to October 2017 in the pediatric neurosurgery department of Shiraz Namazi Hospital, Southern Iran. The authors included 24 patients with large MMC defects who underwent surgery utilizing the bilateral V-Y flap and latissimus dorsi and gluteal muscle advancement. They also retrospectively included 19 patients with similar age, sex, and defect size who underwent surgery using the primary or delayed closure techniques at their center. At least 2 years of follow-up was conducted. The frequency of leakage, necrosis, dehiscence, systemic infection (sepsis, pneumonia), need for ventriculoperitoneal shunt insertion, and mortality was compared between the 2 groups.RESULTSThe bilateral V-Y flap with muscle advancement was associated with a significantly longer operative duration (p < 0.001) than the primary closure group. Those undergoing bilateral V-Y flaps with muscle advancement had significantly lower rates of surgical site infection (p = 0.038), wound dehiscence (p = 0.013), and postoperative CSF leakage (p = 0.030) than those undergoing primary repair. The bilateral V-Y flap with muscle advancement was also associated with a lower mortality rate (p = 0.038; OR 5.09 [95% CI 1.12–23.1]) than primary closure. In patients undergoing bilateral V-Y flap and muscle advancement, a longer operative duration was significantly associated with mortality (p = 0.008). In addition, surgical site infection (p = 0.032), wound dehiscence (p = 0.011), and postoperative leakage (p = 0.011) were predictors of mortality. Neonatal sepsis (p = 0.002) and postoperative NEC (p = 0.011) were among other predictors of mortality in this group.CONCLUSIONSThe bilateral V-Y flap with latissimus dorsi or gluteal advancement is a safe and effective surgical approach for covering large MMC defects and is associated with lower rates of surgical site infection, dehiscence, CSF leakage, and mortality. Further studies are required to elucidate the long-term outcomes.

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