scholarly journals Abdominal midline wound closure with small bites versus large bites: a randomized comparative trial

2020 ◽  
Vol 7 (5) ◽  
pp. 1391
Author(s):  
Rajat Sharma ◽  
Amitpal Kaur ◽  
Mohit Sharma ◽  
Karaninder Singh ◽  
Neeti Rajan Singh
Keyword(s):  
Incisional Hernia ◽  
Wound Infection ◽  
Wound Closure ◽  
Elective Surgery ◽  
Comparative Trial ◽  
Suture Technique ◽  
Abdominal Wound ◽  
Midline Laparotomy ◽  
Significant Difference ◽  
Group A

Background: The optimal strategy of abdominal wall closure after midline laparotomy has remained an issue of ongoing debate to minimize incidence of incisional hernia which occurs in 10 to 23% cases postoperatively. The main objective of the study was to evaluate the efficacy of small bites versus large bites suture technique in reduction of incidence of the complications like pain, wound infection, wound dehiscence, seroma formation and incisional hernia by using polydioxanone no.1.Methods: The present study was conducted on 100 patients undergoing elective surgery who were randomly allocated into group A and B. Group A were the patients in which midline abdominal wound closure was done with small bites and group B were the patients in which midline abdominal wound closure was done with large bites. Then the patients were followed up for 6 months to observe any complications.Results: A mean additional closure time of 9 minutes was seen with the small bites technique. The mean suture length was more in small bites group as compared to large bites technique. There was no difference in the visual analog scale score between the two groups. No significant difference was seen in the incidence of major and minor wound infection postoperatively in both the groups. Small bites technique reduced the incidence of suture sinus and incisional hernia compared to conventional large bites technique.Conclusions: It can be concluded that the small bites suture technique is more effective than the traditional large bites technique for prevention of all post-operative complications.

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

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.

scholarly journals Comparison of efficacy of large tissue bites versus small tissue bites for midline abdominal wound closure

2020 ◽  
Vol 7 (2) ◽  
pp. 455
Author(s):  
Tappa Mahammad Mustaqrasool ◽  
Bharat Dikshit ◽  
Deepak Phalgune
Keyword(s):  
Incisional Hernia ◽  
Surgical Site Infections ◽  
Wound Dehiscence ◽  
Suture Technique ◽  
Fascial Closure ◽  
Abdominal Wound ◽  
Closure Time ◽  
Small Tissue ◽  
Group A ◽  
Group B

Background: Incisional hernia is common complication after median laparotomy, with reported incidence varying between 2% and 20%. For prevention of incisional hernia, many clinical trials and meta-analyses have demonstrated that mass closure technique with simple running suture is good option to close midline incision. An attempt was made in this study to compare efficacy of large tissue bites vs small tissue bites for midline abdominal wound closure.Methods: Three hundred thirty patients admitted for midline laparotomy were randomized into Group A, and Group B. Group A, and Group B patients underwent abdominal closure by small bites technique, and large bites technique respectively. Patients were followed at 7th postoperative day, 1 month, 6 months, and 12 months. Primary outcome measures were incidence of incisional hernia, incidence of postoperative complications like post-operative pain, surgical site infections, wound dehiscence whereas, secondary outcome measure was fascial closure time. Inter-group comparison of categorical, and continuous variables was done using Chi-square test/Fisher’s exact test and unpaired ‘t’ test respectively.Results: Incidence of incisional hernia was significantly higher in large bites suture technique compared to small bites suture technique at 12 months follow up. Mean time required for fascial closure time was significantly higher in small bite group compared to large bite group. There was no statistically significant difference in postoperative pain, surgical site infections, and wound dehiscence among the two groups.Conclusions: The rate of incisional hernia was lower in small bites technique compared with large bites technique in midline abdominal incisions.

scholarly journals Comparison of suture technique (interrupted vs. continuous) with respect to wound dehiscence

2020 ◽  
Vol 72 ◽  
pp. 191-194
Author(s):  
Gopal Sharma ◽  
Nivedita Prashar ◽  
Nikita Gandotra
Keyword(s):  
Wound Infection ◽  
Wound Dehiscence ◽  
Suture Technique ◽  
Emergency Laparotomy ◽  
High Morbidity ◽  
Continuous Suture ◽  
Midline Laparotomy ◽  
Group A ◽  
The Mean ◽  
Group B

Objectives: Post-operative complete wound dehiscence, being an unfortunate and also a very serious complication, is associated with a high morbidity and mortality rate despite the most sophisticated intensive care these patients receive today. The quest for the best closure technique for abdominal incisions continues. To achieve this goal, several modifications in opening the abdomen and closing the wound have been tried. There are many studies in the literature comparing various methods of wound closure, with conflicting results. The aim of the present study was to assess the proportion of wound infection and wound dehiscence in the post-midline laparotomy patients, using interrupted X suture versus continuous suture technique in sheath closure. Material and Methods: A total of 80 patients undergoing vertical midline emergency laparotomy at one of the gynecology units were recruited randomly after taking written informed consent and were equally divided into 40 cases each group (interrupted X suture) and (continuous suture) they were randomized into two groups depending on whether the patient registration number was odd or even. Results: The age of the patients varied from 16 years to 82 years. In Group A, the mean age was 36.75 ± 13.78 years, and in Group B, the mean age of the patients was 38.37 ± 12.56 years. In Group A, 8 (20%) patients had comorbidity, whereas, in Group B, 10 (25%) patients had comorbidity. In Group A, 12 patients had wound infection, while in Group B, ten patients had wound infection (P = 0.001 [statistically significant]). In Group A, two patients had wound dehiscence, while none of the patients in Group B had wound dehiscence (P = 0.001 [statistically significant]). There was no incisional hernia in both the groups. Conclusion: Emergency laparotomy is associated with a higher rate of burst abdomen as compared to elective laparotomy, but using interrupted X suture technique in sheath closure, wound dehiscence can be prevented up to some extent.

scholarly journals A Prospective Study Comparing Continuous Versus Interrupted Suture Techniques in Midline Abdominal Wound Closure

2020 ◽  
Vol 18 (1) ◽  
pp. 63-66
Author(s):  
Shiv Vansh Bharti ◽  
Anup Sharma
Keyword(s):  
Wound Infection ◽  
Wound Closure ◽  
College Teaching ◽  
Wound Complications ◽  
Burst Abdomen ◽  
Midline Laparotomy ◽  
Abdominal Closure ◽  
Group A ◽  
Laparotomy Wound ◽  
Group B

Introduction: Wound closure after midline laparotomy is an essential part of surgery to produce a healthy and a strong scar. There is an alternative interrupted method of closure as compared to conventional continuous method of closure. Many comparative studies have shown different outcomes. So, we wanted to evaluate the outcome of different techniques in our setting. Aims: To compare the outcome of Interrupted abdominal closure and continuous abdominal closure in midline laparotomy wound. Methods: This was a prospective comparative study conducted in the Department of Surgery of Nepalgunj Medical College Teaching Hospital, Kohalpur, Banke, Nepal for a duration of 1 year. A total of 60 patients were selected randomly to receive either continuous or interrupted abdominal closure in midline laparotomy wound. Wound was evaluated in terms of wound discharge, infection and wound dehiscence. Results: The mean age of the patients was 38.38 years. Most commonly, the patients presented with duodenal ulcer perforation with peritonitis. The average time taken for abdomen closure in group A (16.77 minutes) was significantly less as compared to group B (27.77 minutes). The average cost of sutures for group B (Rs 1322.97) was higher than that of sutures for group A (Rs 1118) with p value of <0.01. Wound infection and incidence of burst abdomen were similar in both groups after one month, suture sinus was seen in three patients of group A and four patients of group B (p = 1.0). Incisional hernia was seen in one patient of group A and in none of the patients of group B at three month’s follow-up (p = 1.0). Conclusion: Continuous technique of midline laparotomy wound closure is better in terms of time required for wound closure and costing of suture materials, while showing no difference in terms of wound infection, burst abdomen and late wound complications

scholarly journals Prevalence of Wound Infection in Patients Undergoing Elective or Emergency Abdominal Surgery

2021 ◽  
Vol 15 (7) ◽  
pp. 1697-1699
Author(s):  
Arshid Mahmood ◽  
Aqeel Ahmad ◽  
Muhammad Hammad Muzaffar ◽  
Sarfraz Ahmad
Keyword(s):  
Wound Infection ◽  
Elective Surgery ◽  
Surgical Wound Infection ◽  
Emergency Laparotomy ◽  
Surgical Wound ◽  
Surgical Infection ◽  
Significant Difference ◽  
Group A ◽  
Group B ◽  
Intra Abdominal Infection

Objective: To compare the surgical wound infection in patients undergoing elective or emergency abdominal surgeries. Study Design: Comparative study Place & Duration of Study: Study was conducted at surgery department of Divisional Headquarter Teaching hospital Mirpur Azad Kashmir for eighteen months duration from June 2019 to November 2020. Materials and Methods: 150 patients of both genders with ages 15 to 65 years who received laparotomy treatment due to intra-abdominal infection or complicated appendicitis were included in this study. Patient’s medical history, age, sex and residency were recorded after taking informed consent. All the patients were divided into two groups, Group A contained 75 patients (Elective) and Group B contains 75 patients (emergency) received laparotomy. Deep surgical wound infection was examined at the 7th day after surgery and compared between both groups. Results: Ninety eight (65.3%) patients 49 in each group were males and 52 (34.7%) patients 26 in each group were females. In Group A and B 27 and 29 patients were ages 15 to 30 years, 33 and 31 patients had ages 36 to 45 years, 15 and 15 patients were ages between 46 to 60 years. 10 (13.3%) patients in Group A and 12 (16%) patients in group B had deep surgical infection within 1 week after surgery. Statistically there is no significant difference between the both groups (p>0.356) Conclusion: It is concluded that the frequency of wound infection was high in emergency abdominal surgeries as compared to patients undergoing elective surgery, but the difference was not statistically significant. Keywords: Emergency laparotomy, Deep surgical site infection, PO Drain placement

CLINICAL OUTCOME AND COST COMPARISON OF CARPAL TUNNEL WOUND CLOSURE WITH MONOCRYL® AND ETHILON®: A PROSPECTIVE STUDY

Hand Surgery ◽  
2013 ◽  
Vol 18 (02) ◽  
pp. 189-192 ◽  
Author(s):  
Anis Dosani ◽  
Sameer K. Khan ◽  
Sheila Gray ◽  
Steve Joseph ◽  
Ian A. Whittaker
Keyword(s):  
Carpal Tunnel ◽  
Wound Closure ◽  
Unit Cost ◽  
Cost Effective ◽  
Cost Comparison ◽  
Absorbable Suture ◽  
Significant Difference ◽  
Group A ◽  
Group B ◽  
A Prospective Study

This prospective non-randomised two-cohort study compares the use of an absorbable suture (Poliglecrapone [Monocryl]: Group A) and a non-absorbable suture (Polyamide [Ethilon]: Group B) in wound closure after elective carpal tunnel decompression. The primary outcome was scar cosmesis as assessed by the Stonybrook Scar Evaluation Scale (SBSES); the financial cost of wound closure was compared as a secondary outocome. All fifty patients completed follow-up. At six weeks, there was no significant difference in the two groups regarding scar tenderness (p = 0.5), although residual swelling was more evident in the absorbable group (p = 0.2). The mean SBSES score at six weeks was 4.72 in Group A, and 4.8 in Group B (p = 0.3). The unit cost per closed wound of Monocryl was three times than Ethilon (p < 0.05). Ethilon is thus cost-effective without compromising the cosmetic outcome, and we recommend using this as the preferred suture for closure of carpal tunnel wounds.

scholarly journals Comparison between scalpel incision and electrocautery incision in midline abdominal surgery: a comparative study

2021 ◽  
Vol 8 (5) ◽  
pp. 1507
Author(s):  
Amit Yadav ◽  
Lakshman Agarwal ◽  
Sumit A. Jain ◽  
Sanjay Kumawat ◽  
Sandeep Sharma
Keyword(s):  
Postoperative Pain ◽  
Blood Loss ◽  
Abdominal Surgery ◽  
Wound Infection ◽  
Skin Incision ◽  
P Value ◽  
Wound Area ◽  
Significant Difference ◽  
Group A ◽  
Group B

Background: Fear of poor wound healing have curtailed the use of diathermy for making skin incision. Scalpel produces little damage to surrounding tissue but causing more blood loss. Our aim of study was to compare electrocautery incision with scalpel incision in terms of incision time, blood loss, postoperative pain and wound infection.Methods: Total of 104 patients were included in the study undergoing midline abdominal surgery. Patients were randomized into electrocautery (group A) and scalpel (group B). The incision dimension, incision time and blood loss were noted intraoperatively. Postoperative pain was noted on postoperative day 2 using visual analog scale. Wound complications were recorded on every postoperative day till the patient was discharged.Results: 52 patients in each of the two groups were analyzed. There was significant difference found between group A and group B in terms of mean incision time per unit wound area, 8.16±1.59 s\cm2 and 11.02±1.72 s\cm2 respectively (p value=0.0001). The mean blood loss per unit wound area was found to be significantly lower in group A (0.31±0.04 ml\cm2) as compared to group B (1.21±0.21), p value=0.0001. There was no significant difference noted in terms of postoperative pain and wound infection between both groups.Conclusions: Electrocautery can be considered safe in making skin incision in midline laparotomy compared to scalpel incision with comparable postoperative pain and wound infection with less intraoperative blood loss and less time consuming.

scholarly journals ELECTIVE MIDLINE LAPAROTOMY

2011 ◽  
Vol 18 (01) ◽  
pp. 106-111
Author(s):  
ARSALAN SIRAJ ◽  
ATHAR ABBAS SHAH GILANI ◽  
MUHAMMAD FAROOQ DAR ◽  
Sohail Raziq
Keyword(s):  
Postoperative Pain ◽  
Blood Loss ◽  
Wound Infection ◽  
Visual Analogue Score ◽  
P Value ◽  
Midline Laparotomy ◽  
Pain Scores ◽  
Group A ◽  
Insignificant Difference ◽  
Group B

Objectives: To compare the diathermy incision with scalpel incision in patients undergoing midline elective laparotomy. Design of Study: A prospective, experimental comparative study. Place and Duration: Department of surgery, PNS Shifa Karachi, from March 2007 to June 2008. Patients and Methods: A total of 100 patients were included in the study, and equally divided into 2 groups. Group A received scalpel incision while in group B diathermy was employed to incise all layers. Peroperative parameters including, incision time and blood loss were calculated. Postoperatively, pain was assessed by visual analogue score and wound infection documented. Results: Both groups included fifty patients each out of the total 44 females and 56 were males, with similar gender preposition in both the groups. Mean age of patients in scalpel group was 48.78 (±14.47) while it was 44.92 (±15.87) in diathermy group. The mean incision related blood loss in Scalpel group was 1.53 (±0.20) ml/cm2 and in Diathermy group was 1.43 (±0.20) ml/cm2, showing significantly less bleeding in diathermy group (p-value= 0.014). Diathermy group, with incision related time of 6.20 sec/cm2 (±0.97 sec/cm2), was significantly quicker (p-value= 0.003) than scalpel incision, with incision time of 6.76 sec/cm2 (±0.84 sec/cm2). Postoperative pain scores, recorded daily over five days, showed insignificant difference between the two groups. Conclusions: Diathermy, employed for midline laparotomy, is quicker and hemostatic, compared to the scalpel. The two are, however, similar in terms of wound infection and postoperative pain.

scholarly journals IL-17C and IL-17RE Promote Wound Closure in a Staphylococcus aureus-Based Murine Wound Infection Model

2021 ◽  
Vol 9 (9) ◽  
pp. 1821
Author(s):  
Linda Pätzold ◽  
Alexandra Stark ◽  
Felix Ritzmann ◽  
Carola Meier ◽  
Thomas Tschernig ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Wound Infection ◽  
Wound Closure ◽  
Skin Diseases ◽  
Infection Model ◽  
Interleukin 17 ◽  
Immune Mediated ◽  
Significant Difference ◽  
Infected Skin

The epithelial cytokine interleukin-17C (IL-17C) mediates inflammation through the interleukin 17 receptor E (IL-17RE). Prior studies showed a detrimental role of IL-17C in the pathogenesis of immune-mediated skin diseases (e.g., psoriasis). Here, we examined the role of IL-17C/IL-17RE in wound closure in a Staphylococcus aureus wound infection model. We demonstrate that wound closure is significantly delayed in IL-17RE (Il-17re−/−)- and 17C (Il-17c−/−)-deficient mice. There was no significant difference between WT, Il-17re−/−, and Il-17c−/− mice in the absence of infection. Deficiency for IL-17RE and IL-17C did not significantly affect the elimination of bacteria. IL-17C expression was increased in the epidermis of human S. aureus-infected skin. Our results indicate that the IL-17C/IL-17RE axis contributes to the closure of infected wounds but does not contribute to the elimination of S. aureus.

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

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) &gt; 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.”

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