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Research Paper | General Surgery | India | Volume 12 Issue 1, January 2023
A Clinical Study on Wound Dehiscence in Patients Undergoing Emergency Exploratory Laparotomy
Dr. Pingili Sirija | Dr. Anne Akhil | Dr. P. Venkata Ramana Reddy [2]
Abstract: Introduction: Abdominal wound dehiscence (Acute wound failure or a burst abdomen) refers to the post operative separation of the abdominal musculoaponeurotic layers. It is one of the most dreaded complications faced by surgeons and is of the greatest concern because of the need for intervention, the risk of evisceration, surgical wound infection, recurrence, and incisional hernia formation. Dehiscence most often develops around 7 to 10 days post operatively but may occur even up to 20 days. Despite major advancements in the preoperative care of surgical patients, which includes the introduction of broader spectrum antibiotics and an improved understanding of all the effects of systemic illness on wound healing, the incidence of wound dehiscence has remained constant. It is one of the most serious postoperative complications; the incidence in the adult population is reported to be as0.3-3.5%, and among the elderly it is as high as 10%. Aims and Objectives: To study the incidence and factors contributing to wound dehiscence in patients undergoing emergency exploratory laparotomy patients. To compare the events and factors between dehiscence and non-dehiscence patients to find the factors that have significant. Association with wound dehiscence in emergency exploratory laparotomy patients. To analyze with special reference to pre-operative serum albumin, hemoglobin and obesity as the predictive factors of wound dehiscence in emergency exploratory laparotomy patients. Methodology: This is a cohort study with sample size of 50. The study was conducted in the Department of surgery, Kamineni Institute of Medical Sciences, Narketpally, from October 2020- September 2022. The source of data was patients who underwent laparotomy. Inclusion criteria: 1) Patients undergoing emergency exploratory laparotomy. 2) Patients aged more than 12 years. Exclusion criteria: 1) Patient on steroids, immunosuppressant or anticancer therapy. Patients aged less than 12 years. 3) Patient undergoing re-explorative laparotomy. Results: Male preponderance is noted in wound dehiscence patients. Most of the patients belonged to age group of <45 years. Perforation peritonitis is the most common cause for which emergency laparotomy took place. Next leading cause was malignancy. If there is absence of combination of all the three factors- pre-operative anemia, hypoalbuminemia and obesity, there is higher chance that the patient will not develop wound dehiscence. Conclusion: Wound dehiscence is a serious sequel of impaired wound healing. Inspite of medical advancement, frequency of wound dehiscence in emergency laparotomy remains high.Multiple factors together predispose to this grave complication. Knowledge of the more common mechanisms and highly contributing factors willhelp to keep high risk patients under strict surveillance to reduce the incidence of this notorious complication. Various putative risk factors for abdominal wounddehiscence were investigated and significant risk factors for abdominal wound dehiscence identified in this study are pre-operative hypoalbuminemia, pre-operative anemia, intra-abdominalsepsis/ wound infection and obesity.
Keywords: Wound dehiscence, laparotomy
Edition: Volume 12 Issue 1, January 2023,
Pages: 651 - 657