Complete Dehiscence of the abdominal wound and incriminating factors
Second Surgical Department of Medical Faculty of the Aristoteles University of Thessaloniki, G Gennimatas Hospital, Greece. The European Journal of Surgery
06/2001; 167(5):351-4; discussion 355. DOI: 10.1080/110241501750215221
To find out the causes of abdominal wound dehiscence.
University hospital, Greece.
Abdominal wound dehiscence occurred in 89 cases out of 19,206 major abdominal operations including 4671 emergencies during the past 15 years (0.5%).
In the study group 14 local and systemic risk factors were analysed and compared with those in a control group of 89 patients who had similar procedures without dehiscence.
Statistical analysis using the chi square test.
Significant factors (p < 0.05) included age over 65 years, emergency operation, cancer, haemodynamic instability, intra-abdominal sepsis, wound infection, hypoalbuminaemia, ascites, obesity, and steroids. Risk factors that were not significant included sex, anaemia, diabetes mellitus and pulmonary disease. Overall morbidity and mortality were 30% and 16%, respectively. The mortality and the possibility of dehiscence seem to correlate directly with the number of risk factors.
Patients with these risk factors require more attention and special care to minimise the risk of its occurrence.
Available from: Saeed Shoar
- "Patients younger than 18 y and those with an incision length of <10 cm were excluded from the study. Patients who died in the 2-wk period after the surgery were considered lost to follow-up because most fascial dehiscences occur during this period  . The types of surgery were categorized as malignancy resection, gastrointestinal (GI) obstruction, GI bleeding, intra-abdominal infection, trauma, and miscellaneous. "
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Abdominal wound dehiscence (WD) is a postoperative complication with high mortality and morbidity rates. Retention sutures are often used in surgical take-back for dehiscence. The aim of this study was to assess the reduced rate of dehiscence in midline laparotomy using prophylactic retention sutures in high-risk patients.
Materials and methods:
Three hundred high-risk patients with at least two risk factors for dehiscence who underwent midline laparotomy between 2008 and 2010 were randomly divided into two groups. In the control group, the fascia was continuously repaired using a running looped #1 nylon suture. For the intervention group, we added retention sutures that included the skin, subcutaneous tissue, rectus muscle, and abdominal fascia. We compared the rates of WD, evisceration, wound infection, postoperative pain, postdehiscence mortality, and late incisional hernia for these two groups.
After accounting for early mortalities, 147 patients were followed in the intervention group and 148 patients in the control group. WD occurred in 6 patients (4%) in the intervention group and 20 control patients (13.3%) (P = 0.007). Abdominal evisceration after surgery occurred in 1 patient (0.7%) with retention sutures and 4 control patients (2.7%) (P = 0.371). There was no significant difference in wound infection and incisional hernia between the two groups. Postoperative pain scores between the two groups did not differ significantly during the first 3 d, but did differ on the fourth day.
Prophylactic retention sutures reduce the occurrence of WD following midline laparotomy in high-risk patients with multiple risk factors for impaired wound healing without imposing remarkable postoperative complications.
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ABSTRACT: Management of the surgical patient with liver disease begins with a careful preoperative assessment (Fig. 1). Any clues to liver disease on history and physical examination should be investigated to ascertain the cause of the clinical finding. More data on surgical patients with unexpected liver disease are now available. Patients undergoing emergent surgery are at significant risk of developing liver dysfunction. Child's class still correlates strongly to postoperative complications. Cornerstones of perioperative management in these patients are medical treatment of complications of chronic liver disease, such as ascites; coagulopathy; prevention of encephalopathy; and rapid treatment of dangerous postoperative complications, such as acute acalculous cholecystitis. Evolving knowledge of the effects of anesthesia, improving surgical techniques, and use of better diagnostic tests will help in the reduction of perioperative complications in these patients.
Available from: Kenneth Bodziak
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ABSTRACT: Mycophenolate mofetil (MMF) and sirolimus impair wound healing. We compared sirolimus vs. MMF to determine the relative impact on surgical complications and wound healing in adult kidney transplant recipients. This retrospective, single center study of 235 adult kidney transplants performed between 1 January 2000 and 31 January 2002 identified 158 adult, kidney-only recipients treated with tacrolimus and prednisone, from which two groups were defined: group 1 (n = 84) received MMF, group 2 (n = 74) received sirolimus. The incidence of fluid collections, wound problems, dehiscence, and urine leak were compared. A multivariate stepwise logistical regression analysis was performed to identify risk factors. The overall incidence of complications was 21.5%, with rates significantly lower in group 1 (2.4%) vs. group 2 (43.2%, p < 0.0001). Regression analysis showed only sirolimus (p < 0.001) and hypo-albuminemia (p = 0.006) to independently correlate with complication occurrence. In subanalyses, lymphoceles correlated only with sirolimus (p = 0.003), while other wound problems also correlated with higher body mass index (p = 0.067). The use of sirolimus, tacrolimus and prednisone was associated with a greater incidence of lymphoceles, non-lymphocele perinephric fluid collections and other consequences of poor wound healing, as compared to contemporary patients treated with MMF, tacrolimus and prednisone.
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