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

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.

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 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.

scholarly journals Outcome of abdominal binder in midline abdominal wound Dehiscence in terms of pain, psychological satisfaction and need for reclosure

2021 ◽  
Vol 37 (4) ◽  
Author(s):  
Ahmed Siddique Ammar ◽  
Syed Asghar Naqi ◽  
Shehrbano Khattak ◽  
Ahmed Raza Noumani
Keyword(s):  
Sampling Technique ◽  
Wound Dehiscence ◽  
P Value ◽  
Emergency Laparotomy ◽  
Abdominal Wound ◽  
Creative Commons ◽  
Surgical Ward ◽  
Group A ◽  
Abdominal Wound Dehiscence ◽  
Group B

Objective: To assess the role of abdominal binder in patients with midline wound dehiscence after elective or emergency laparotomy in terms of pain, psychological satisfaction and need for reclosure. Methods: It was a comparative study done at EAST Surgical Ward of Mayo Hospital, Lahore from 1st January 2018 to 31st December 2019. One hundred and sixty-two (162) patients were included in this study with post-operative midline abdominal wound dehiscence and after informed consent by consecutive non probability sampling technique. Patients were divided into two groups by lottery method into eighty-one patients each. Group-A included patients where abdominal binder was applied and Group-B included patients without abdominal binder. In both groups pain score, psychological satisfaction and need for reclosure was assessed and compared. Results: Patients with abdominal binder shows significantly less pain (P value =0.000) and more psychological satisfaction (P value = 0.000) as compared to the patients where abdominal binder was not used. However, there was no difference in reducing the need for reclosure in patients who use abdominal binder (P value = 0.063). Conclusion: Although abdominal binder helps in reducing the pain and improving the psychological satisfaction in patients with midline abdominal wound dehiscence yet it doesn’t help in healing of wound and reclosure of the dehisced abdominal wound is needed. doi: https://doi.org/10.12669/pjms.37.4.3671 How to cite this:Ammar AS, Naqi SA, Khattak S, Noumani AR. Outcome of abdominal binder in midline abdominal wound Dehiscence in terms of pain, psychological satisfaction and need for reclosure. Pak J Med Sci. 2021;37(4):1118-1121.  doi: https://doi.org/10.12669/pjms.37.4.3671 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

scholarly journals Primary versus delayed wound closure technique in laparotomy wound of perforation peritonitis

2019 ◽  
Vol 6 (10) ◽  
pp. 3708
Author(s):  
M. N. Sasikumar ◽  
Sam Christy Mammen
Keyword(s):  
Hospital Stay ◽  
Wound Infection ◽  
Primary Closure ◽  
Wound Closure ◽  
Wound Dehiscence ◽  
Infection Rates ◽  
Saline Irrigation ◽  
Primary Wound Closure ◽  
Group A ◽  
Perforation Peritonitis

Background: There is no consensus on the ideal techniques for wound closure of contaminated wounds. Multiple techniques have been proposed. The aim of the study is to compare the wound infection rates of laparotomy wounds in perforation peritonitis in primary and delayed primary wound closure. The purpose is comparison of primary wound closure and delayed primary wound closure with respect to rate of wound infection and other associated complications like wound dehiscence, stitch sinuses, incisional hernias and duration of hospital stay.Methods: This study included 106 patients, divided into two groups, primary closure (A) in which wound was primarily closed and secondary closure (B) in which wound was left open without suturing and saline irrigation was given and were sutured once the wound is clean and culture sterile. The wound infection was assessed using Southampton scoring system.Results: A total of 106 patients, 60 (56.6%) males and 46 (43.4%) females were included. Group A, 53 patients with 54.7% males and 45.3% females and in B, 53 patients with 58.5% males and 41.5% females. The mean age in A was 38.4 11.8while that in B 37.02 12.59. Group A had an infection rate of 77.4%whereas group B had only 34%. The duration of hospital stay for B was 9.72 2.57 and for group A, 11.74 2.87days.Conclusions: The delayed primary closure is the optimal technique for wound closure in contaminated wounds like perforation peritonitis as it reduces wound infection rates and hospital stay.

scholarly journals Triclosan coated vicryl versus uncoated vicryl in preventing surgical site infection: a randomized controlled trial

2020 ◽  
Vol 8 (1) ◽  
pp. 103
Author(s):  
Amitpal Kaur ◽  
Mohit Sharma ◽  
Karaninder Singh ◽  
Darpan Bansal
Keyword(s):  
Surgical Site Infection ◽  
Wound Closure ◽  
Elective Surgery ◽  
Controlled Trial ◽  
Wound Dehiscence ◽  
Signs And Symptoms ◽  
Site Infection ◽  
Health Care Associated Infections ◽  
Group A ◽  
Group B

Background: Surgical site infection (SSI) are one of the most frequently reported health care associated infections. They are commonly associated with greater morbidity, readmissions, ICU admissions, long-term surgical site complications and mortality. Multiple global studies have shown level 1A clinical evidence that the use of triclosan coated suture reduces the incidence of SSI by 30%.Methods: In the proposed prospective study, 100 cases undergoing elective surgery were randomly allocated into Group A and B. Group A were the patients in which wound closure was done using triclosan coated vicryl (vicryl plus) and group B were the patients in which wound closure was done using uncoated vicryl. Then, the patients were followed up for 30 days to observe any signs and symptoms of surgical site infection.Results: Duration as well as severity of pain was decreased in vicryl plus group as compared to uncoated vicryl. Other signs of inflammation such as erythema, swelling, induration and fever were also less in patients who had wound closure using vicryl plus. Wound dehiscence was not observed in either of the groups. Discharge was seen in 1 patient in vicryl plus group but it was seen in 5 patients in uncoated vicryl group. Surgical site infection was seen only in 1 patient in the vicryl plus group, but it was seen in 10 patients uncoated vicryl group.Conclusions: It can be concluded that triclosan coated vicryl (vicryl plus) is better than uncoated vicryl for the prevention of surgical site infection.

scholarly journals Abdominal Wound Dehiscence: A Review of Risk Factors, Prevention and Management in Obstetrics and Gynecology Practice

Medicinus ◽  
2021 ◽  
Vol 8 (3) ◽  
pp. 102
Author(s):  
Gezta Nasafir Hermawan ◽  
Jacobus Jeno Wibisono ◽  
Lidya F Nembo
Keyword(s):  
Risk Factors ◽  
Wound Closure ◽  
Wound Dehiscence ◽  
Health Centers ◽  
Obstetrics And Gynecology ◽  
Abdominal Wound ◽  
Burst Abdomen ◽  
Incidence And Mortality ◽  
Complete Disruption ◽  
Abdominal Wound Dehiscence

<p>Abdominal wound dehiscence (AWD) is considered as a severe postoperative complication in which there is a partial or complete disruption of an abdominal wound closure with or without protrusion and evisceration. The incidence and mortality rate varies in different health centers. Risk factors are classified into three groups, which includes: pre-operative, intra-operative, and post-operative. The management of Burst Abdomen or Wound Dehiscence is diverse from conservative treatment to surgical treatment.</p>

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

2018 ◽  
Vol 5 (5) ◽  
pp. 1690 ◽  
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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