A Prospective Study of Factors Influencing Wound Dehiscence after Midline Laparotomy
- 1 Department of Surgery, Lady Hardinge Medical College and Smt. Sucheta Kriplani Hospital, New Delhi, India
- 2 Department of Surgery, Lady Hardinge Medical College and Smt. Sucheta Kriplani Hospital, New Delhi, India
- 3 Department of Surgery, Safdarjung Hospital, New Delhi, India
- 4 Department of Surgery, Lady Hardinge Medical College and Smt. Sucheta Kriplani Hospital, New Delhi, India
- 5 Department of Surgery, Lady Hardinge Medical College and Smt. Sucheta Kriplani Hospital, New Delhi, India
- 6 Department of Surgery, Lady Hardinge Medical College and Smt. Sucheta Kriplani Hospital, New Delhi, India
- 7 Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
Abstract
Aim: To evaluate the factors influencing fascial wound dehiscence after midline laparotomy in the patients of perfora tion peritonitis with an emphasis on measurement of “intra-abdominal” pressure (IAP) and fascial transforming growth factor-beta (TGF-beta). Methods: Hundred eligible adult patients with the diagnosis of perforation peritonitis who un derwent emergency exploratory laparotomy were prospectively recruited. Forty five patients who developed midline abdominal wound dehiscence were compared with 55 patients without dehiscence. Results: The variables that were significantly associated with wound dehiscence include anemia, hypo proteinemia, duration of surgery, prolonged postoperative ileus, wound infection and postoperative pulmonary infection. Age, gender, jaundice, cause of peritonitis, wound contamination and types of surgery were non significant variables. The mean IAP value in the patients with dehiscence was significantly higher than “non-dehiscence” group (p = 0.000). The patients with wound dehiscence strongly expressed TGF-beta on the day of burst. Conclusion: The patients of peritonitis undergoing prolonged surgery in the presence of risk factors like anemia, hypo proteinemia, postoperative ileus, wound infection and postoperative pulmonary infection have high risk of abdominal wound dehiscence.
- T. T. Irvin, C. J. Stoddard, et al., “Abdominal Wound Healing: A Prospective Clinical Study,” British Medical Journal, Vol. 2, No. 6083, 1977, pp. 351-352. doi:10.1136/bmj.2.6083.351
- G. Madsen, L. Fisher and P. Wara, “Burst Abdomen Clinical Features and Factors Influencing Mortality,” Danish Medical Bulletin, Vol. 39, No. 2, 1992, pp. 183-185.
- A. G. Greenberg and R. P. Saik, “Wound Dehiscence— Pathophysiology and Prevention,” Archives of Surgery, Vol. 114, No. 2, 1979, pp. 143-146. doi:10.1001/archsurg.1979.01370260033004
- P. Bradley, M. C. Pickett, P. A. Lawrence, et al., “Tensile Strength vs Healing Time for Wounds Closed under Tension,” Archives of Otolaryngology—Head and Neck Surgery, Vol. 122, No. 2, 1996, pp. 565-568. doi:10.1001/archotol.1996.01890170097017
- M. Sedrak and K. Major, “Simple Fluid Column Manometry to Monitor for the Intra-Abdominal Pressure,” Contemporary Surgery, Vol. 50, No. 5, 2002, pp. 27-29.
- J. M. Bruch, E. E. Moore, F. A. Moore, et al., “The Abdominal Compartment Syndrome,” Surgical Clinics of North America, Vol. 76, No. 4, 1996, p. 833. doi:10.1016/S0039-6109(05)70483-7
- J. D. Bancroft and M. Gamble, “Theory and Practice of Histological Techniques,” Churchill Livingstone, London, 2002.
- G. V. Poole and N. C. Winston-Salem, “Mechanical Factors in Abdominal Wound Closure: The Prevention of Fascial Dehiscence,” Surgery, Vol. 97, No. 6, 1985, pp. 631-639.
- R. B. Bettman and M. W. Kobak, “Relative Frequency of Evisceration after Laprotomy in Recent Years,” Journal of the American Medical Association, Vol. 172, No. 16, 1960, p. 1764. doi:10.1001/jama.1960.63020160001007
- J. T. Makela, H. Kiviniemi, T. Juvonen, et al., “Factors Influencing Wound Dehiscence after Midline Laparotomy,” The American Journal of Surgery, Vol. 170, No. 4, 1995, p. 387. doi:10.1016/S0002-9610(99)80309-2
- J. P. Riou, J. R. Cohen and H. Johensen, “Factors Influencing Wound Dehiscence,” The American Journal of Surgery, Vol. 163, No. 3, 1992, pp. 324-330. doi:10.1016/0002-9610(92)90014-I
- T. E. Bucknall and H. Ellis, “Abdominal Wound Closurea Comparison of Monofilamental Nylon and Polyglycolic Acid,” Surgery, Vol. 89, No. 6, 1981, pp. 672-677.
- C. Knight and F. D. Groffen, “Abdominal Wound Closure with a Continuous Monofilament Polypropylene Suture,” Archives of Surgery, Vol. 118, No. 11, 1923, pp. 1305-1308. doi:10.1001/archsurg.1983.01390110053012