Early versus late dressing removal in clean and contaminated midline laparotomy wounds: a non-randomized pilot study

Background: This study was carried out to evaluate the efficacy of early versus late dressing removal in clean and contaminated midline laparotomy wounds.Methods: Fifty patients aged ≥18 years who were admitted and operated for surgical procedures (both emergency and elective) were included in the study. All laparotomy wounds had fulfilled the CDC criteria. Twenty-five patients each were included in early dressing removal group and the late removal group. In early removal group, the laparotomy wound dressing was removed within 48 hours and in late removal group, was removed after 48 hours of surgery. The incidences of superficial and deep surgical site infection (SSI) in both groups were analysed. Other secondary parameters like incidence of wound dehiscence and secondary suturing were also analysed.Results: Twenty-five patients each, in early removal group and in late removal group were included for final analysis. The incidence of superficial SSI (%) was significantly less in early removal group (65.50 versus 89.50; p= <0.001). The duration (days) required for complete wound healing (8.52 versus 10.65; p=0.734) was significantly less in the early removal group. The length of postoperative hospital stay (days) was significantly less in early removal group (10.30 versus 14.90; p= <0.001).Conclusions: Early removal of dressing significantly reduces the incidence of superficial SSI in midline clean and contaminated laparotomy wounds. It also significantly reduces the duration required for complete wound healing and facilitates early discharge of the patient compared to late dressing removal.

Download Full-text

Usefulness of a needleless suture technique for midline laparotomy wound dehiscence: a case report

Trauma Image and Procedure ◽

10.24184/tip.2021.6.1.22 ◽

2021 ◽

Vol 6 (1) ◽

pp. 22-24

Author(s):

Da Yeon Lee ◽

Pil Young Jung

Keyword(s):

Wound Healing ◽

Case Report ◽

Wound Dehiscence ◽

Cost Effective ◽

Suture Technique ◽

Surgical Wound ◽

Midline Laparotomy ◽

Surgical Wound Dehiscence ◽

Surgical Incisions ◽

Laparotomy Wound

Surgical wound dehiscence after a laparotomy is a serious complication, and it presents the mechanical wound healing failure of surgical incisions. Since the development of needleless suture techniques, there have been attempts to use a needleless suture for wounds from several surgery types. Recently, many studies have shown that a needleless suture technique leads to good wound healing results. It is rapid, cost effective, can minimize ventilator dependency, and is well tolerated by patients. Here, we report a case of a patient who received a needleless suture technique for midline laparotomy wound dehiscence.

Download Full-text

A comparative study between continuous and x-interrupted sutures in emergency midline laparotomies

International Surgery Journal ◽

10.18203/2349-2902.isj20181437 ◽

2018 ◽

Vol 5 (5) ◽

pp. 1753

Author(s):

Shashikala V. ◽

Abhilash S. B. ◽

Abhishek G. ◽

Prajwal S. Fernandes

Keyword(s):

Suture Material ◽

Rectus Sheath ◽

Surgical Site Infections ◽

Wound Dehiscence ◽

Midline Laparotomy ◽

Group A ◽

Common Technique ◽

Laparotomy Wound ◽

Group B ◽

Time Required

Background: Midline laparotomy is the most common technique of abdominal incisions in both emergency and elective settings. Wound dehiscence is related to several factors pertaining to patient besides suture material and method of closure. This study tries to compare continuous sutures with x-interrupted sutures in mass closure of midline laparotomy wound in patients undergoing emergency midline laparotomy for acute peritonitis.Methods: A total of 60 patients undergoing emergency midline laparotomy for secondary peritonitis were considered for the study, 30 of whom underwent closure of abdominal wall with continuous sutures (Group A) and the other 30 with x-interrupted sutures (Group B) using non-absorbable, monofilament, polypropylene suture. Necessary preoperative data, the time required for rectus closure, length of the suture material required, post-operative complications like surgical site infection, wound dehiscence were analyzed.Results: The groups were comparable in means of age and sex distribution. Group A was found to have lesser time for closure of rectus, lesser suture length and lesser suture to wound length ratio when compared with Group B. Surgical site infections were similar in both groups. Patients with rectus sheath sutured in x-interrupted sutures (n=2) had significantly less wound dehiscence as compared with continuous sutures (n=8) (p<0.05).Conclusions: Interrupted -X suture method of suturing reduces post-operative wound dehiscence, although requires more suture and consumes more time than the continuous method of suturing.

Download Full-text

Comparison of Laparotomy Wound Dehiscence (LWD) Rate Using Interrupted X-Suture Technique vs Continuous Suture Technique in Rectus Sheath in Emergency Laparotomy

Journal of Saidu Medical College, Swat ◽

10.52206/jsmc.2021.11.3.646 ◽

1969 ◽

Vol 11 (3) ◽

pp. 133-136

Author(s):

Fazli Akbar ◽

Muhammad Khan ◽

Nisar Ahmad ◽

Shah Abbas ◽

Nadeem Khan

Keyword(s):

Rectus Sheath ◽

Wound Dehiscence ◽

Suture Technique ◽

P Value ◽

Emergency Laparotomy ◽

Continuous Suture ◽

Midline Laparotomy ◽

Group I ◽

Laparotomy Wound ◽

Group Ii

Background: Emergency laparotomy is one of the most commonly performed surgeries in emergency situations of generalsurgery department. This can be performed for multiple causes. Wound closure is one of the main component of outcomes of thissurgery. Some surgeons prefer continuous closure ofthe linea Alba while other prefer interrupted closure technique.Objective: To compare the frequency of laparotomywound dehiscence (LWD) using continuous suture technique with interruptedX-suture technique inrectus sheath for emergency laparotomy wound closure.Materials & Methods: This randomized controlled trial was conducted on adult patients who were planned for emergency midlinelaparotomy in the department of general surgery of Saidu Group of Teaching Hospitals, Swat. The study was conducted fromJanuary 2019 to November 2019. We included 200 patients and divided them into two equal groups. Group I; In these patients,abdominal incision was closed using continuous suture technique.Group II; inthese patients, interrupted X-suture technique wasused for closure of abdominal wound incision. Patients were evaluated daily for 7 days and after that, at 15, h day, to diagnose thewound dehiscence on clinical evaluation.Results:Mean age was 43.8 ± 8.7 years in group I and42.6 ± 10.9 years in groupII(p-value 0.39). There were 77%male patients ingroup I and 74% in group II (p-value 0.74). Peritonitis due to gut perforation was the commonest etiology, with 63% proportion ingroup I versus 68% in group II (p-value 0.55). Laparotomy wound dehiscence was diagnosed in 15% patients in group I versus3.0% patients in group II (p-value 0.006).Conclusion: Interrupted X-suture technique is better than continuous suture technique for abdominal wall closure afteremergency midline laparotomy.Interrupted X-suture technique has significantly loweredthe frequency of wound dehiscence.Keywords:Acute abdomen, emergency midline laparotomy,laparotomy wound dehiscence.

Download Full-text

Open versus Closed Hemorrhoidectomy - An Experience at Mayo Hospital

Annals of King Edward Medical University ◽

10.21649/akemu.v9i1.1326 ◽

2016 ◽

Vol 9 (1) ◽

Cited By ~ 1

Author(s):

Muhammad Shoaib ◽

Abrar Ashraf Ali ◽

Nabeel Naqvi ◽

Khalid Masood Gondal ◽

Abdul Majeed Chaudhry

Keyword(s):

Wound Healing ◽

Wound Dehiscence ◽

Postoperative Hospital Stay ◽

Analgesic Requirement ◽

Closed Technique ◽

Complete Wound Healing ◽

Closed Hemorrhoidectomy ◽

One Year ◽

Open Versus ◽

Surgical Unit

Hemorrhoids are a common problem that affects a larger group of population. It affects both sexes and is more common in the more prosperous societies, perhaps related to exercise, diet and bowel habits. The objective of the study was to compare the outcome of the two conventional methods of haemorrhoidectomy, open and closed techniques for 3rd degree prolapsing and complicated haemorrhoids. This would be a non-interventional type of study comparing the two methods conducted at surgical unit-1 Mayo Hospital, Lahore comprising of fifty patients selected randomly and equally divided in two groups. No statistically significant differences were found between the two methods regarding complications and postoperative hospital stay (P>0.05). Pain and the analgesic requirement on the day of surgery and the first postoperative day was significantly lower (P<0.05) in open haemorrhoidectomy group. Complete wound healing took longer in open haemorrhoidectomy as compared to closed technique, 3 patients suffered wound dehiscence after closed haemorrhoidectomy. Only 4% in each group develop recurrence after one year. Open haemorrhoidectomy leads to more reliable wound healing with lesser complications, though heeling time is more as compared to the closed technique. Both techniques are fairly efficient for treating third degree haemorrhoids.

Download Full-text

Realistic Advantages of Early Surgical Drain Removal after Pancreatoduodenectomy: A Single-Institution Retrospective Study

Journal of Clinical Medicine ◽

10.3390/jcm10122716 ◽

2021 ◽

Vol 10 (12) ◽

pp. 2716

Author(s):

So-Jeong Yoon ◽

So-Kyung Yoon ◽

Ji-Hye Jung ◽

In-Woong Han ◽

Dong-Wook Choi ◽

...

Keyword(s):

Enhanced Recovery ◽

Single Institution ◽

Early Removal ◽

Drain Removal ◽

Early Return ◽

Drain Fluid ◽

Pancreatic Fistulas ◽

Hospital Stays ◽

Removal Group ◽

Surgical Drain

The latest guidelines from the Enhanced Recovery After Surgery (ERAS®) Society stated that early drain removal after pancreatoduodenectomy (PD) is beneficial in decreasing complications including postoperative pancreatic fistulas (POPFs). This study aimed to ascertain the actual benefits of early drain removal after PD. The data of 450 patients who underwent PD between 2018 and 2020 were retrospectively reviewed. The surgical outcomes were compared between patients whose drains were removed within 3 postoperative days (early removal group) and after 5 days (late removal group). Logistic regression analysis was performed to identify the risk factors for clinically relevant POPFs (CR-POPFs). Among the patients with drain fluid amylase < 5000 IU on the first postoperative day, the early removal group had fewer complications and shorter hospital stays than the late removal group (30.9% vs. 54.5%, p < 0.001; 9.8 vs. 12.5 days, p = 0.030, respectively). The incidences of specific complications including CR-POPFs were comparable between the two groups. Risk factor analysis showed that early drain removal did not increase CR-POPFs (p = 0.163). Although early drain removal has not been identified as apparently beneficial, this study showed that it may contribute to an early return to normal life without increasing complications.

Download Full-text

COMPARISON OF WOUND HEALING RATE AND TIME TO COMPLETE WOUND HEALING ACCORDING TO WOUND LOCATION IN CRITICAL LIMB ISCHEMIA

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(13)62105-1 ◽

2013 ◽

Vol 61 (10) ◽

pp. E2105

Author(s):

Norihiro Kobayashi ◽

Muramatsu Toshiya ◽

Tsukahara Reiko ◽

Ito Yoshiaki ◽

Hirano Keisuke

Keyword(s):

Wound Healing ◽

Critical Limb Ischemia ◽

Healing Rate ◽

Limb Ischemia ◽

Complete Wound Healing ◽

Wound Healing Rate

Download Full-text

Hyperbaric oxygen treatment for University of Texas grade 3 diabetic foot ulcers: a retrospective cohort study

Journal of Wound Care ◽

10.12968/jowc.2021.30.9.722 ◽

2021 ◽

Vol 30 (9) ◽

pp. 722-728

Author(s):

Rutger C Lalieu ◽

Willem Mulder ◽

René D Bol Raap ◽

Saskia Stolk ◽

Casper Smit ◽

...

Keyword(s):

Wound Healing ◽

Cohort Study ◽

Retrospective Cohort ◽

Wound Care ◽

Complete Healing ◽

Foot Ulcers ◽

Diabetic Foot Ulcers ◽

University Of Texas ◽

Complete Wound Healing ◽

Grade 3

Aim: Hard-to-heal diabetic foot ulcers (DFUs) may increase the risk of amputation. This study reports the positive influence of hyperbaric oxygen therapy (HBOT) on hard-to-heal DFUs involving underlying bone. Method: A single-centre, retrospective cohort study reporting the results of HBOT and wound care on hard-to-heal University of Texas grade 3 DFUs (i.e., involving underlying bone) between 2013 and 2019. Outcome measures were primarily (near-) complete wound healing (i.e., ≥80% ulcer surface area reduction) and amputation rate (minor or major), and secondarily the number of hyperbaric sessions and improvement in quality of life (QoL) and pain score. Results: The study included 206 patients, of whom 74 (36%) achieved complete wound healing, and 75 (36%) near-complete healing. Amputations were performed in 27 patients (13%): 12 (6%) minor and 15 (7%) major. The median number of HBOT sessions was 42. Participants who achieved complete healing received a median of 43 sessions, compared with 10 for those who required major amputation. Patients with at least 30 sessions were less likely to undergo amputation (odds ratio: 0.08; 95% confidence interval (CI): 0.03–0.21). Mean QoL increased by 7.6 points (95%CI: 3.9–11.3; p<0.01) and median pain score fell from 3 to 1 (0–3) (p<0.01). Conclusions: The addition of HBOT to standard wound care may lead to a decreased amputation risk, improved wound healing and increased QoL for people with a University of Texas grade 3 DFU. An adequate number of HBOT sessions is required to achieve optimal clinical results. Objective selection criteria and shared decision-making are suggested to improve dropout rates.

Download Full-text

Updates in Diabetic Wound Healing, Inflammation, and Scarring

Seminars in Plastic Surgery ◽

10.1055/s-0041-1731460 ◽

2021 ◽

Author(s):

Nina Dasari ◽

Austin Jiang ◽

Anna Skochdopole ◽

Jayer Chung ◽

Edward Reece ◽

...

Keyword(s):

Wound Healing ◽

Disease Process ◽

Wound Dehiscence ◽

Diabetic Patients ◽

Wound Infections ◽

Diabetic Wound ◽

Complex Process ◽

Diabetic Wound Healing ◽

Almost All ◽

Diabetic Wounds

AbstractDiabetic patients can sustain wounds either as a sequelae of their disease process or postoperatively. Wound healing is a complex process that proceeds through phases of inflammation, proliferation, and remodeling. Diabetes results in several pathological changes that impair almost all of these healing processes. Diabetic wounds are often characterized by excessive inflammation and reduced angiogenesis. Due to these changes, diabetic patients are at a higher risk for postoperative wound healing complications. There is significant evidence in the literature that diabetic patients are at a higher risk for increased wound infections, wound dehiscence, and pathological scarring. Factors such as nutritional status and glycemic control also significantly influence diabetic wound outcomes. There are a variety of treatments available for addressing diabetic wounds.

Download Full-text

P100 EARLY POSTOPERATIVE WOUND COMPLICATIONS AFTER MIDLINE LAPAROTOMY CLOSURE WITH SMALL BITES TECHNIQUE: EXPERIENCE FROM A TERTIARY REFERRAL CENTRE

British Journal of Surgery ◽

10.1093/bjs/znab395.093 ◽

2021 ◽

Vol 108 (Supplement_8) ◽

Author(s):

Adomas Gudelis ◽

Gintaras Simutis ◽

Julius Pacevicius

Keyword(s):

Abdominal Wall ◽

Surgical Site Infections ◽

Wound Dehiscence ◽

Patient Characteristics ◽

University Hospital ◽

Wound Complications ◽

Tertiary Referral Centre ◽

Midline Laparotomy ◽

Group A ◽

Wound Length

Abstract Aim To analyze the incidence and risk factors of surgical site infections (SSI) and wound dehiscence (WD) after closure of primary midline laparotomies with small-bites (SB) technique. Material and Methods Retrospective analysis using hospital prospective database of all midline abdominal wall closures (AWC) with SB technique performed in a University Hospital between December 2019 and February 2021. To achieve a proper protocol of AWC with SB technique, it is advised to have suture/wound length (SL/WL) – ratio of more than 4:1. Statistical analysis of the incidence of SSI and AWD, comparing the results when the protocol was properly used (A group) or not (B group), was performed. Between groups, no relevant differences were observed for patient characteristics. Results A total of 108 midline laparotomies were included for analysis. 55.5% of patients were male. The mean age was 62.8 years, mean body mass index was 24.3 kg/m2. 78.7% (85/108) were operated electively. SSI and WD have been recorded in 7 (6.5%) and 8 (7,4%) cases respectively. In 65 (60,2%) patients abdominal wall closure after primary laparotomy was achieved with proper protocol (group A). Median SL/WL in A and B group was 4.57 and 3.43 respectively. The rate of WD in A group (n = 1, 1,5%) was significantly (P=.006) lower than in B group (n = 7, 16,3%). Incidence of SSI was 7,7% (n = 5, A group) vs. 4,7% (n = 2; B group) (P=.420). Conclusions Using a proper AWC protocol has been effective to prevent WD in midline laparotomy.

Download Full-text

P055 THE USE OF ARTIFICIAL NEURAL NETWORK TO PREDICT THE RISK OF INCISIONAL HERNIA AFTER MIDLINE LAPAROTOMY

British Journal of Surgery ◽

10.1093/bjs/znab395.051 ◽

2021 ◽

Vol 108 (Supplement_8) ◽

Author(s):

Edgard Efren Lozada Hernandez ◽

Tania Aglae Ramírez del Real ◽

Dagoberto Armenta Medina ◽

Jose Francisco Molina Rodriguez ◽

Juan ramon Varela Reynoso

Keyword(s):

Neural Network ◽

Artificial Neural Network ◽

Logistic Regression ◽

Incisional Hernia ◽

False Negative ◽

Wound Dehiscence ◽

Midline Laparotomy ◽

Significant Difference ◽

Positive Rate ◽

Artificial Neural

Abstract Aim “Incisional Hernia (IH) has an incidence of 10-23%, which can increase to 38% in specific risk groups. The objective of this study was developed and validated an artificial neural network (ANN) model for the prediction of IH after midline laparotomy (ML) and this model can be used by surgeons to help judge a patient’s risk for IH.” Material and Methods “A retrospective, single arm, observational cohort trial was conducted from January 2016 to December 2020. Study participants were recruited from patients undergoing ML for elective or urgent surgical indication. Using logistic regression and ANN models, we evaluated surgical treated IH, wound dehiscence, morbidity, readmission, and mortality using the area under the receiver operating characteristic curves, true-positive rate, true-negative rate, false-positive rate, and false-negative rates.” Results “There was no significant difference in the power of the ANN and logistic regression for predicting IH, wound dehiscence, mortality, readmission, and all morbidities after ML. The resulting model consisted of 4 variables: surgical site infection, emergency surgery, previous laparotomy, and BMI(Kg/m2) > 26. The patient with the four positive factors has a 73% risk of developing incisional hernia. The area under the curve was 0.82 (95% IC 0.76-0.87). Conclusions “ANNs perform comparably to logistic regression models in the prediction of IH. ANNs may be a useful tool in risk factor analysis of IH and clinical applications.”

Download Full-text