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.

Delayed Primary Closure in Damage Control Laparotomy: The Value of the Wittmann Patch

2007 ◽  
Vol 73 (1) ◽  
pp. 10-12 ◽  
Author(s):  
Josef G. Hadeed ◽  
Gregory W. Staman ◽  
Hector S. Sariol ◽  
Sanjay Kumar ◽  
Steven E. Ross
Keyword(s):  
Primary Closure ◽  
Damage Control ◽  
Trauma Surgery ◽  
High Rate ◽  
Damage Control Laparotomy ◽  
Abdominal Closure ◽  
Delayed Primary Closure ◽  
Accepted Practice ◽  
Planned Relaparotomy ◽  
Temporary Closure

Damage control laparotomy has become an accepted practice in trauma surgery. A number of methods leading to delayed primary closure of the abdomen have been advocated; complications are recognized with all these methods. The approach to staged repair using the Wittmann patch (Star Surgical Inc., Burlington, WI) combines the advantages of planned relaparotomy and open management, while minimizing the rate of complications. The authors hypothesized that use of the Wittmann patch would lead to a high rate of delayed primary closure of the abdomen. The patch consists of two sheets sutured to the abdominal fascia, providing for temporary closure. Advancement of the patch and abdominal exploration can be done at bedside. When the fascial edges can be reapproximated without tension, abdominal closure is performed. Twenty-six patients underwent staged abdominal closure during the study period. All were initially managed with intravenous bag closure. Eighty-three per cent (20 of 24) went on to delayed primary closure of the abdomen, with a mean time of 13.1 days from patch placement to delayed primary closure. The rate of closure using the Wittmann patch is equivalent to other commonly used methods and should be considered when managing patients with abdominal compartment syndrome or severe abdominal trauma.

scholarly journals A comparative study on surgical site infections after primary closure and delayed primary closure in clean contaminated laparotomy cases

2019 ◽  
Vol 6 (3) ◽  
pp. 989
Author(s):  
T. J. Pauly ◽  
T. V. Haridas ◽  
E. Manoj Prabhakar ◽  
Roshjo Roshan
Keyword(s):  
Surgical Site Infection ◽  
Primary Closure ◽  
Surgical Site Infections ◽  
P Value ◽  
Skin Closure ◽  
Site Infection ◽  
Chi Square ◽  
Delayed Primary Closure ◽  
Laparotomy Wound ◽  
Clean Contaminated

Background: Surgical site infection is a significant cause of post operative morbidity. Timing of skin closure following a surgery and its relation to incidence of infection has been studied. The debate whether primary or delayed primary closure have been around for a long time. The aim of this study is to compare the rate of infection in a laparotomy wound in clean contaminated laparotomy cases after primary and delayed primary closure.Methods: 132 patients who underwent laparotomy for clean contaminated were selected. Of this primary closure of the skin was done in 66 cases and delayed primary closure at 48 hours were done in the other 66 patients. Wounds were followed up till post op day 7. The results between two groups were compared using chi square test.Results: two out of 66 cases developed SSI in the delayed primary sutured group whereas 8 out of 66 cases developed SSI in primary suturing group. The results were compared using chi square test and the chi square statistic was 3.8951 and the p value is 0.048428 (<0.05) proving the result significant.Conclusions: The incidence of surgical site infection in laparotomy wound after a primary closure was higher compared to delayed primary closure in clean contaminated laparotomy wounds and the difference is significant based on statistical evaluation.

Postoperative Neuromuscular Blocker Use Is Associated With Higher Primary Fascial Closure Rates After Damage Control Laparotomy

2010 ◽  
Vol 69 (3) ◽  
pp. 557-561 ◽  
Author(s):  
Chadi T. Abouassaly ◽  
William D. Dutton ◽  
Victor Zaydfudim ◽  
Lesly A. Dossett ◽  
Timothy C. Nunez ◽  
...  
Keyword(s):  
Damage Control ◽  
Neuromuscular Blocker ◽  
Fascial Closure ◽  
Damage Control Laparotomy ◽  
Primary Fascial Closure

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 A randomised study to evaluate wound outcome following delayed primary vs primary closure of skin in duodenal perforation peritonitis

2021 ◽  
Vol 8 (7) ◽  
pp. 2108
Author(s):  
Sajal Gupta ◽  
Vimal Bhandari ◽  
I. B. Dubey
Keyword(s):  
Primary Closure ◽  
Surgical Site Infections ◽  
Wound Dehiscence ◽  
Duodenal Perforation ◽  
P Value ◽  
Randomised Study ◽  
Delayed Primary Closure ◽  
Significant Difference ◽  
Perforation Peritonitis ◽  
Stitch Abscess

Background: This study aimed to evaluate wound outcome following delayed primary versus primary closure of skin in duodenal perforation peritonitis.Methods: The present study was a randomised interventional study that included 90 patients on accrual of duodenal perforation peritonitis which were divided into primary closure (PC) and delayed primary closure (DPC) groups comprising 45 patients each. The outcome measures were complications, surgical site infections, hospital stay and final wound status during the follow up of 30 days. Data collected was compared taking P-value <0.05 as significant.Results: The patients were in the age group of 12–60 years, with men in majority in both groups. Mean SSI score in PC and DPC was comparable (2.67 SD 1.58 vs. 2 SD1.61, P=0.058). SSI was more in PC group than DPC group (11.11% vs. 2.22%, P<0.05). Wound/pus culture was positive in 62.22% in PC and 46.67% in DPC. Major complications like wound dehiscence was noticed mainly in PC group while minor Complications like Stitch abscess, granuloma, sinus was more in DPC group. Mean of duration of stay (days) was comparable between PC and DPC group (14.07 SD 7.64 vs. 13.96 SD 6.94, P=0.805). Final wound outcome after 30 days was healthy scar in majority of patients in PC and DPC group (57.78% vs. 66.67%) with no significant difference between them (p=0.434).Conclusions: In conclusion, DPC showed comparable results with PC with similar SSI and wound healing without significant complications.

scholarly journals Difference Between Delayed Anastomosis and Early Anastomosis in Damage Control Laparotomy Affecting the Infusion Volume and NPWT Output volume: Is Infusion Restriction Necessary in Delayed Anastomosis? A Single-Center Retrospective Analysis

2021 ◽  
Author(s):  
Yohta Tanahashi ◽  
Hisaho Sato ◽  
Akiko Kawakami ◽  
Shusaku Sasaki ◽  
Yu nishinari ◽  
...  
Keyword(s):  
Retrospective Analysis ◽  
Emergency Surgery ◽  
Damage Control ◽  
Fascial Closure ◽  
Temporary Abdominal Closure ◽  
Artificial Anus ◽  
Single Center ◽  
Damage Control Laparotomy ◽  
Second Look ◽  
Output Volume

Abstract Background: Delayed anastomosis is a treatment strategy used in damage control laparotomy (DCL). During temporary abdominal closure (TAC) with DCL, infusion volume, and negative-pressure wound therapy (NPWT) output volume are associated with the success and prognosis of primary fascial closure (PFC). The same may also hold true for anastomosis. The aim of this research is to evaluate whether the difference between early anastomosis and delayed anastomosis in DCL is related to infusion volume and NPWT output volume.Methods: This single-center retrospective analysis targeted patients managed with TAC during emergency surgery for trauma or intra-abdominal sepsis between January 2011 and December 2019. It included patients who underwent repair/anastomosis/artificial anus construction in the first surgery and patients who underwent intestinal resection in the first surgery followed by delayed anastomosis with no intestinal continuity. The main outcomes were infusion volume, NPWT output volume and complications.Results: One hundred nine patients who underwent emergency surgery were evaluated. Seventy-three patients were managed with TAC using NPWT. In 16 patients with early anastomosis and 21 patients with delayed anastomosis, there was no difference in the infusion volume (p=0.2318) or NPWT output volume (p=0.7128) 48 hours after surgery. Additionally, there was no difference in the occurrence of surgical site infection (p=0.315) and suture failure (p=0.8428). During the second-look surgery after 48 hours, the anastomosis was further postponed for 48% of the patients who underwent delayed anastomosis. There was no difference in the infusion volume (p=0.0783) up to the second-look surgery between the patients whose delayed anastomosis was postponed and those who underwent delayed anastomosis, but there was a tendency toward a large NPWT output volume (p=0.024) in the postponed delayed anastomosis group. Anastomosis and PFC were achieved for all patients whose delayed anastomosis was postponed.Conclusions: The presence or absence of anastomosis during TAC management does not affect NPWT output volume. Delayed anastomosis may be managed with the same infusion volume as that used for early anastomosis. There is also the option of postponing anastomosis if the planned delayed anastomosis is complicated.Trial RegistrationThe retrospective protocol of this study was approved by our institutional review board (MH2018-611).

Evolution of Fascial Closure Optimization in Damage Control Laparotomy

2016 ◽  
Vol 82 (12) ◽  
pp. 1178-1182
Author(s):  
Margaret H. Lauerman ◽  
Joseph J. Dubose ◽  
Deborah M. Stein ◽  
Samuel M. Galvagno ◽  
Matthew J. Bradley ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Odds Ratio ◽  
Damage Control ◽  
Enterocutaneous Fistula ◽  
Fascial Closure ◽  
Damage Control Laparotomy ◽  
Closure Rate ◽  
Urban Level ◽  
Level I ◽  
Primary Fascial Closure

Management of patients undergoing damage control laparotomy (DCL) involves many surgical, medical, and logistical factors. Ideal patient management optimizing fascial closure with regard to timing and closure techniques remains unclear. A retrospective review of patients undergoing DCL from 2000 to 2012 at an urban Level I trauma center was undertaken. Mortality of DCL decreased over the study period from 62.5 to 34.6 per cent, whereas enterocutaneous fistula rate decreased from 12.5 to 3.8 per cent. Delayed primary fascial closure rate improved from 22.2 to 88.2 per cent. Time to closure ( P < 0.001), time to first attempted closure ( P < 0.001), and number of explorations ( P < 0.001) were associated with ability to achieve delayed primary fascial closure. In subgroup analysis, achievement of delayed primary fascial closure was decreased with time to closure after one week (91.7% vs 52.0%, P = 0.002) and time to first attempted closure after two days (86.5% vs 70.0%, P = 0.042). In multivariate analysis, time to closure (odds ratio: 0.13, 95% confidence interval: 0.04–0.39; P < 0.001) and time to first attempted closure (odds ratio: 0.61, 95% confidence interval: 0.37–0.99; P = 0.046) were the only factors associated with achieving delayed primary fascial closure. Timing of attempted closure plays a significant role in attaining delayed primary fascial closure, highlighting the importance of early re-exploration.

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