CLINICAL STUDY ON FACTOR INFLUENCING WOUND DEHISCENCE
Main Article Content
Keywords
Wound Dehiscence, Peritoneal Infection, Dyslipidemia, Malnutrition, Dyselectronemia
Abstract
Background: Wound dehiscence is defined as partial or complete disruption of an sutured abdominal laprotomy wound. It is one of the most dreaded complications which is faced by surgeons and one of greatest concern as there is high risk of evisceration, need for immediate intervention. Abdominal wound bursts and viscera are extruded mainly between the sixth to eighth day postoperatively, in around 1 -2% of laprotomy cases. Various risk factors are responsible for abdominal wound dehiscence eg. intraabdominal infection, emergency surgery, advanced age >65yrs, malnutrition, anaemia, hypoalbuminaemia, high BMI, systemic diseases like uremia and diabetes mellitus.
Method: 200 patients were studied in period from Oct 2019 to November 2021 who went emergency laprotomy at RIMS, Ranchi for various conditions like perforation obstruction etc and they were assessed for riskfactors associated with wound dehiscence including age BMI, details regarding presenting complaints, duration, associated diseases, significant risk factors like, anaemia, malnutrition, obesity was noted.
Result: Our study shows that of abdominal wound dehiscence incidence was more common in male gender 61%. In our study malespredominated as M:F ratio was 1.74:1. In our study the mean age of patients shown to be 46,27 years as the incidence ofduodenal ulcer perforation was more common in this age group54 (27%) of the patients studiedwere operated for hollow viscus perforation among which includes Duodenal ulcerperforation, ileal perforation, gastric perforation and jejunal perforation. In our study 82.5% of patients who underwent emergency surgery developed abdominal wound dehiscence (p < 0.001). In our study 51.5 ofpatients had anaemia, 45% had malnutrition, 35.5% had DM,28% had cough,45% had dyselectronemiaand sepsis being amajor determinant with 64.5% of the cases.
Conclusion: The most important factor in predicting wound dehiscence was Intraperitoneal infection. Factors act as determinant for wound dehiscence were– older age group, anaemia, male sex, obesity, malnutrition, patients with peritonitis due to bowel perforation, cough, Dyselectronemia. Postoperative abdominal wound dehiscence can be prevented by strict aseptic precautions, improving the nutritional status of the patient, improving patients respiratory pathology to prevent post operative cough and by proper surgical technique.
References
2. Wagar SH, Malik ZI, Razzaq A, Abdulah MT, Shaima A, Zahid MA. Frequency and risk factors for wound dehiscence/burst abdomen in midline laparotomies. JAyub Med Coll Abbottabad 2005Oct-Dec;7(4):70-3.
3. Poole GV. Mechanical factors in abdominal wound closure: the prevention offascial dehiscence. Surg 1985 Jun;97(6):631-40.
4. Gurleyik G. Factors affecting disruption of surgical abdominal incisions in earlypostoperative period. UlusTravmaDerg 2001 Apr;7(2):96-9
5. Lazarus GS, Cooper DM, Knighton DR, et al. Definitions and Guidelines for
Assessment of Wounds and Evaluation of Healing. Arch Dermatol 1994;
130;489-493.
6. John. W. Madden, Arnold. J Arem. Wound healing; biologic and clinical features. The biologic basis of modem surgical practice. Edition XIII; Vol I; Page 193.
7. Riou JPA, Cohen JR, Johnson H. Factors influencing wound dehiscence. Am J
Surg 1992 March;163:324-329.
8. Makela JT, Kiviniemi H, Juvonen T, Laitinen S. Factors influencing wound
dehiscence after midline laparotomy. Am J Surg 1995 Oct;170:387-389.
9. Khan MN, Naqvi AH, Irshad K, Chaudhary AR. Frequency and risk factor of
abdominal wound dehiscence. Coll Physicians Surg Pak 2004 Jun;14(6):355-7.
10. Burger JW, Van‘t Riet M, Jeekel J. Abdominal incisions: techniques and postoperative complications. Scand J Surg 2002; 91: 315-21.
11. Afzal S., Bashir M.M. Determinants of Wound Dehiscence in Abdominal Surgery inPublic Sector Hospital. Annals vol14. NO. 3 jul-sept. 2008
12. Spiliotis J, Konstantino S, Tsiveriotis, Datsis AD, Archodaula, Georgios et al. Wound Dehiscence. World Journal of Emergency surgery 2009;4:12.
13. Waqer S, Malik Z, Razzaq A, et al.: Frequency and risk factors for wound
dehiscence/burst abdomen in midline laparotomies. Journal Ayub Med Coll 2005,
17(4):70-73.
14. Col C, Soran A, Col M: Can postoperative abdominal wound dehiscence be predicted? Tokai J ExpClin Med 1998, 23(3):123-127.
15. Riou JPA, Cohen JR, Johnson H. Factors influencing wound dehiscence. Am J Surg1992 March; 163:324-329.
16. Makela JT, Kiviniemi H, Juvonen T, Laitinen S. Factors influencing wound
dehiscence after midline laparotomy. Am J Surg 1995 Oct; 170:387-389.
17. Khan MN, Naqvi AH, Irshad K, Chaudhary AR. Frequency and risk factor of
abdominal wound dehiscence. Coll Physicians Surg Pak 2004 Jun;14(6):355-7
18. Grantcharov TP, Rosenberg J. Vertical compared with transverse incision in
abdominal surgery. Eur J Surg 2001 Apr;167(4):260-7
19. Ramneesh G, Sheerin S, Surinder S, Bir S. A prospective study of predictors for
postlaparotomy abdominal wound dehiscence. J Clin Diagn Re .2014;8(1):80-83.
20. Yrki T, Makela A, Kiviniemi H, Juvonen T, Laitinen S. Factors Influencing
Wound Dehiscence After Midline Laparotomy. The American Journal ofSurgery1995; 170:387-390.
21. Sivender A Ilaiah M, Reddy S. A Clinical study on risk factors causing abdominalwound dehiscence and management. IOSR Journal of Dental and MedicalSciences 2015; 14(10):18-23.
22. Afzal S., Bashir M. Determinants of Wound Dehiscence in Abdominal Surgery in
Public Sector Hospital. Annals 2008;4(3):44-46.
23. Cownsend CM, Deauchant RD, Evers BM, Mattox KL. Wound healing. In :
Ethridge RT, Leong M, Phillis LG. edt., Sabiston‘s Textbook of Surgery, 18th Ed.,Vol.1, Chapter 8, Elsevier Publishers, 2008:p.191-206.
24. Mahmoud N. Kulaylat, MD Merril T. Dayton, MD. surgical complications. Sabiston text book of surgery 19th edn.p283-284.
25. BoleyNM.Anteriour abdominal wall.40th ed. In: Grays Anatomy, Standring S
(ed). Philadelphia: Elsevier Churchill Livingstone;2005
26. Savage A, Lamont M. Wound dehiscence, incisional hernia, and parastomal hernia. Morris PJ, Wood WC,edts., Oxford text book of surgery.2nd edn. Alison Langton;2000;p.1883
27. Nyhus and Condonshernia.Diagnostic and Imaging of abdominal wall hernia 5 thedition; p 432-433
28. Mahmoud N. Kulaylat, MD Merril T. Dayton, MD. surgical complications. Sabiston text book of surgery 19th edn. p 283-284.
29. AnuraygSrivastas et al Prevention of burst abdominal wound by new technique: A randomized trial comparing continuous versus interrupted sutures.
30. W. Robert Rout; Abdominal incision; Chapter 21: Shackel Fords Surgery of alimentary tract 5 edition volume II: 334-37.
31. Afzal S., Bashir M.M. Determinants of Wound Dehiscence in Abdominal Surgery in Public Sector Hospital. Annals vol14. NO. 3 jul-sept. 2008
32. Bryan M. Burt, Ali Tavakkolizadeh, Stephen J. Ferzoco. Incisions, Closures, and Management of the Abdominal Wound.Maingots abdominal operation 11thedn:97-99.
33. Gabrie¨lle H. van Ramshorst • JeroenNieuwenhuizen •Wim C. J. Hop • Pauline Arends • Johan Boom. Johannes Jeekel • Johan F. Lange. Abdominal Wound Dehiscence in Adults: Developmentand Validation of a Risk Model.World J Surg 2010) 34:20–27.
34. Frank H. Netter, MD, 2014, Atlas of Human Anatomy, Seventh Edition, page 252-258.
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
Dr Rajat Kumar Singh
Senior Resident, Dept. of General Surgery, Medinirai Medical College, Palamu
Dr Renu Yadav
Senior Resident, Dept of Gynaecology, Laxmi Chandravansi Medical College, Palamu
Dr Avnish Kumar Tarwey
Senior Resident Dept. of Biochemistry, Medinirai Medical College, Palamu
Dr Deepak Kumar Kachhap
Junior Resident, Department of Surgery, RIMS Ranchi