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ORIGINAL ARTICLE
Management of abdominal wound dehiscence: still a
challenge
Abdul Qaiyoume Amini, Naveed Ali Khan, Javed Ahmad, Amjad Siraj Memon
Abstract:
Objective: To find out the effective way of management of abdominal wound dehiscence after
emergency and elective laparotomies.
Materials and methods: The study was carried out in Surgical Unit 5, Civil Hospital Karachi
during January 2011 to April 2012. One hundred and thirty consecutive patients undergoing
laparotomy through a midline incision either in emergency or elective setup were included in
the study. They were followed by wound examination from second post operative day onwards
to see normal or otherwise healing and findings were recorded. The cases of wound dehiscence were divided into two groups i.e. group A, managed with thorough abdominal wash and
deep tension sutures and group B, managed with thorough abdominal wash and Bogota bag
application.
Results: 15 out of 130 (11.5%) patients developed complete wound dehiscence (burst abdomen). Frequency of burst abdomen was significantly higher after emergency laparotomies
(14/94 i.e. 14.89%) while 1 patient undergoing elective laparotomy developed burst abdomen
(1/36 i.e. 2.7%). Group A (n=8) was managed with deep tension sutures and group B (n=7)
was managed with Bogot bag. The outcome of deep tension sutures was associated with less
morbidity, less number of further surgeries and low mortality.
Conclusion: Thorough abdominal wash with copious amount of normal saline and closure
with deep tension sutures is still an effective way of management of patients with complete
wound dehiscence while Bogot bag application is useful in cases abdominal closure is difficult due to generalized gut edema or need of further re-operations.
Keywords: Abdominal wound dehiscence, midline laparotomy, deep tension suture, Bogota
bag, burst abdomen
Civil Hospital Karachi
AQ Amini
NA Khan
J Ahmad
AS Memon
Correspondence:
Abdul Qaiyoume Amini
Resident year 4, Surgical
Unit 5, Civil Hospital
Karachi,
Postal Address: House
No. A-141, Behind Jama
Masjid Afzal, Gulistan-eJauhar block 14, Karachi.
email: aqamini@yahoo.
com, Cell: 0345-2340172
Pak J Surg 2013; 29(2):84-87
Introduction:
Abdominal wound dehiscence (burst abdomen) is a severe post operative complication
experienced by surgeons who do a significant
volume of surgery. The incidence as described
in the international literature range from 0.4 to
3.5%1-7 and is associated with a mortality rate
as high as 45%8-10 while our local data showed
still higher frequency of wound dehiscence
with overall rate of 4.8 and 6.6%11,12. Abdominal
wound dehiscence can result in evisceration, requiring immediate treatment.
Despite increased knowledge about wound
healing, advances in perioperative care and suture materials, wound dehiscence continues to
be a significant problem which prolongs hospital stay and is associated with patients morbidity, subsequent re-operations, high incidence of
incisional hernia and increased mortality. This
may be attributable to increasing rates of emergency laparotomies in high risk patients with
multiple comorbids outweighing the benefits of
technical achievements.2,7,13
The management of wound dehiscence ranges
from simple dressing to further surgery for abdominal wash and subsequent closure of burst
85
Cases of complete wound dehiscence (burst abdomen) were divided randomly into two groups
i.e. group A, managed with thorough abdominal wash and deep tension sutures and group B,
managed with thorough abdominal wash and
application of Bogot bag. In group A patients,
deep tension sutures applied using 1.0 prolene
with suture 2 cm from wound edges and 3 cm
apart with a plastic tube of 4 cm length to avoid
cutting of skin. Interrupted mattress sutures also
applied in between the deep tension sutures.
In Group B, Bogot bag applied, made from
transparent side of a urine bag and sutured on
all sides of open wound at least 3 cm apart from
wound edges. Patients of both groups received
broad spectrum antibiotics and daily sterilized
dressing by a doctor.
Results:
A total of 130 patients underwent laparotomy
through a midline incision during the study
period. Mean age of patients was 34.22 years
(standard deviation: 14.9) including 86 males
(66.2%) and 44 females (33.8%). Male to female ratio was 2:1. Emergency laparotomies for
various pathologies were done in 94 patients
(72.3%) while elective laparotomies were performed on 36 patients (27.7%).
Out of 130 patients undergoing a midline
laparotomy, 15 developed complete wound
dehiscence (burst abdomen) giving an overall frequency of 11.5% although emergency
laparotomies showed a much higher frequency
(14/94 i.e. 14.89%) while 1 patient developed
burst abdomen after an elective laparotomy
(1/36 i.e. 2.7%). Majority of cases were dirty
having gut perforations and a fecal peritonitis
(11/15 i.e. 73.3%). [Table 1]
Group A patients (n=8) were managed with
thorough abdominal wash and deep tension
sutures while group B patients (n=7) were managed with abdominal wash and application of
Bogot bag.
The mean length of stay was longer in group
B (39.14 12.95) with patients requiring 2 or
more abdominal washes and later development
Pak J Surg 2013; 29(2): 84-87
86
40
Group B (Bogot)
Diagnosis
Frequency
No of Burst Abdomen
35
Group A (DTS)
TB Abdomen
21
30
Gunshot Abdomen
19
25
17
20
16
15
Perf DU
10
10
Colorectal tumor
Perforated Apendix
Sigmoid Volvulus
Biliary perotonitis
Gangrenous Bowel
Stab Wound
Pancreatitis
Others
Total
130
15
Incisional
hernia
Mortality (%)
Mean Length
of stay in days
Abdominal
washes
Incisional
hernia
Mortality
(%)
Group A (DTS)
18.5
25
Group B (Bogot)
39.14
25
28.6
87
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