|Year : 2020 | Volume
| Issue : 1 | Page : 34-37
A clinical study of abdominal wound dehiscence with emphasis on its risk factors
Pratibha Kumari1, Pravin Kumar2, Satya Kumari1, Sangeeta Pankaj3
1 Senior Resident, Dept. of Gynecological Oncology, IGIMS, Bhagalpur, India
2 PG Student, Dept. of general surgery, JLNMC, Bhagalpur, India
3 Professor & Head, Gynecological oncology, IGIMS, Patna, India
|Date of Submission||07-Aug-2019|
|Date of Acceptance||16-Jan-2020|
|Date of Web Publication||16-Nov-2020|
Prof. & Head Gynecological Oncology, SCI, IGIMS, Patna
Source of Support: None, Conflict of Interest: None
Objective : Abdominal wound dehiscence (AWD) is a terminology which is commonly used to explain partial or complete disruption of abdominal wound closure with or without protrusion of abdominal contents. It is among the most feared post operative complications faced by surgeons and is of greatest regard because of risk of burst abdomen, with mortality rates reported as high as 45%. Incidence in literature ranges from 0.4% to 3.5%. This study is designed to highlight the risk factors associated with wound dehiscence, the incidence rate and curative measures to prevent or reduce the occurrence of wound dehiscence and to predict the outcome of the management of abdominal wound dehiscence.
Material and Methods : This retrospective study was done in which total number of 50 Patients admitted in the department of gynecological oncology who underwent routine laparotomies and who developed abdominal wound dehiscence were included in the study.
Results : A total of 50 patients who developed wound dehiscence were included in the study, Out of these, 05 patients had developed complete disruption of abdominal wound (burst abdomen). 45 (90%) cases had the dehiscence occurring in laparotomies done for malignancy cases. Incidence was highest in cases of midline incision.
Conclusion : Burst abdomen is a serious sequel of impaired wound healing. It occurs most commonly in the 31-40 year age group, predominately in laparotomy for malignancy and vertical midline abdominal incisions. Many factors can pre-dispose to this grave complication. Knowledge of the more common mechanisms and how to avoid or overcome these hazards should help to reduce the incidence of this dangerous complication.
Keywords: Abdominal wound dehiscence, burst abdomen, incisional hernia, secondary intention.
|How to cite this article:|
Kumari P, Kumar P, Kumari S, Pankaj S. A clinical study of abdominal wound dehiscence with emphasis on its risk factors. J Indira Gandhi Inst Med Sci 2020;6:34-7
|How to cite this URL:|
Kumari P, Kumar P, Kumari S, Pankaj S. A clinical study of abdominal wound dehiscence with emphasis on its risk factors. J Indira Gandhi Inst Med Sci [serial online] 2020 [cited 2021 Dec 6];6:34-7. Available from: http://www.jigims.co.in/text.asp?2020/6/1/34/300736
| Introduction|| |
Abdominal wound dehiscence (AWD) is a terminology which is commonly used to explain separation of different layers of an abdominal wound before complete healing has taken place. Other terms used interchangeably are acute laparotomy, wound failure and burst abdomen. Wound dehiscence usually occurs when a wound fails to achieve required strength to withstand stresses placed upon it. Dehiscence occurs when overwhelming forces disrupt sutures, when absorbable sutures dissolve too rapidly or when tight sutures cut through tissues through unnecessary pressure.
Acute wound failure may be partial or complete. In partial dehiscence, only the superficial layers or part of the tissue layers reopen. In complete wound dehiscence, all layers of the wound thickness are separated, revealing the underlying tissue and organs, which may protrude out of the separated wound. It is one amongst the most feared post-operative complications for the surgeons and is of greatest regard because of risk of burst abdomen, the need for immediate intervention, and the possibility of repeat dehiscence, surgical site infection, and incisional hernia formation. Abdominal wound dehiscence is reported to be a severe postoperative complication that leads to higher mortality rate as high as 45%, higher implicit, explicit and social costs as well as increased readmission rates.,
Various risk factors are responsible for development of wound dehiscence such as emergency surgery, intraabdominal infection, malnutrition (hypoalbuminemia, anaemia), advanced age, systemic diseases, etc. knowledge of these risk factors is compulsory for adopting prophylaxis measures. Close observation and early intervention is beneficial for patients identified as high risk. This study is designed to highlight the risk factors associated with wound dehiscence, the incidence rate in this hospital and curative measures to prevent or reduce the occurrence of wound dehiscence and to predict the outcome of the management of abdominal wound dehiscence. This will undoubtedly lessen mortality and morbidity in the form of prolong duration of hospital stay, increased economic burden on health care resources and long term complications of incisional hernia.
Our institute is facing the problem of wound dehiscence frequently which lead us to study the frequency, risk factors, management & complications of wound dehiscence.
| Materials and Method|| |
This is a retrospective study carried out from July 2018 to June 2019 in the Department of Gynecological oncology, IGIMS, Patna. A total number of 50 Patients admitted in the department who underwent routine laparotomies and who developed abdominal wound dehiscence were included in the study.
| Inclusion Criteria|| |
Patient admitted in department of gynecological oncology and undergoing routine laparotomies who developed abdominal wound dehiscence after Laparotomy.
| Exclusion Criteria|| |
Age group below 18years wound dehiscence on sites other than the abdomen.
A comprehensive history and thorough physical examination with any other relevant history were recorded.
| Results|| |
A total of 50 patients who developed wound dehiscence were included in the study, Out of these, 05 patients had developed complete disruption of abdominal wound (burst abdomen). 45 (90%) cases had the dehiscence occurring in laparotomies done for malignancy cases. Incidence was highest in cases of midline incision, as it was commonly used incision. Poor nutritional status, anemia, postoperative cough, diabetes were found significant as the risk factors. Incidence of wound dehiscence is most common in age group of 31-40 years & most common post operative day is 7th. 32 patients were managed conservatively in the form of application of abdominal binder and dressing daily & 13 patients were managed by delayed suturing after subsidence of infection. five patient underwent emergency laparotomy for burst abdomen and mesh repair was done.
Incidence of wound dehiscence in different age groups wound dehiscence in relation to type of incision.
Total hospital stay
| Discussion|| |
Wound dehiscence after abdominal operation is a multifactorial problem in which local and systemic factors are involved. Surgical expertise, type of incision, suturing material, surgical site infection, nutritional status, persistent cough, abdominal distension, leakage of pancreatic enzymes , anaemia, obesity, diabetes, jaundice, old age, emergency operation, colon surgeries, and late wound healing due to malignancy have all been suggested to predispose to wound dehiscence. Some of these factors are unavoidable.
Morbidity in the form of prolonged hospital stay, increased economic burden on health care resources and long term complication of incisional hernia can be reduced by highlighting the risk factors for wound dehiscence, the incidence rate and remedial measures to prevent or reduce the incidence of wound dehiscence.
This study has analysed the possible causes and risk factors of wound dehiscence, the management of these patients preoperatively, intra -operatively, postoperatively and evaluated the outcome of each case.
In Our clinical study, a total of 50 cases that developed wound dehiscence were included. Spectrum of cases from complete disruption of abdominal wound dehiscence, to wound gaping were included and 05 cases with complete disruption of abdominal wound (burst abdomen) were present in our study.
Our study showed that abdominal wound dehiscence is more commonly in patients operated for malignancy. The explanation for the maximum incidence of burst abdomen on 7th post-operative day may be due to holding capacity of the sutures is reduced gradually & attains peak around 7th day, due to infection or sloughing of wound margins.
In our study, 32 out of 50 patients were treated conservatively in form of daily dressings. Those patients who were not fit for surgery were managed conservatively and later on followed by delayed suturing of dehiscence. The wound healed by secondary intention due to healthy granulation tissue which developed day by day.
5 out of 50 patients were treated by immediate resuturing of the wound. Resuturing was done as mass closure with Ethilon no. 1. Thirteen patients out of 50 were treated initially with conservative treatment and then, when granulation tissue developed, delayed
| Conclusion|| |
Burst abdomen is a serious sequel of impaired wound healing. It occurs most commonly in the 31-40 year age group, predominately in laparotomy for malignancy and vertical midline abdominal incisions. Many factors can predispose to this grave complication. Knowledge of the more common mechanisms and how to avoid or overcome these hazards should help to reduce the incidence of this dangerous complication Significant risk factors for the development of postoperative abdominal wound dehiscence are: Patient factors like older age group, anaemia, malnutrition, smoking,obesity, patients with malignant tumors,chronic pulmonary disease, renal insufficiency or diabetes.
Procedure related factors like operation type,, type of incision and closure,,,, length of operation time. Postoperative parameters like coughing, clean wound classification, wound infection,. Operative factors like expertise of surgeon,,, and whether surgery is emergent,.
Surgeon factors like midline incisions, improper suture technique and improper aseptic precautions which may lead to wound infection and then wound dehiscence.
Postoperative wound dehiscence can be reduced by improving the nutritional status of the patient, by taking strict aseptic precautions, by improving patients respiratory pathology to avoid postoperative cough.
Patients who developed burst abdomen were managed surgically, either immediate suturing of the wound or delayed suturing of the wound was done.
| References|| |
Hannan EL, Bernard HR, O’Donnell JF, et al. A methodology for targetìng hospital cases for quality of care record reviews. Am J Public Health 1989;79:430-6. 10.2105/AJPH.79.4.430 [PMC free artìcle] [PubMed] [CrossRef] [Google Scholar]
van Ramshorst GH, Nieuwenhuizen J, Hop WC, et al. Abdominal wound dehiscence in adults: development and validation of a risk model. World J Surg 2010;34:20-7. 10.1007/s00268-009-0277-y [PMC free article] [PubMed] [CrossRef] [Google Scholar]
Kean J. The effects of smoking on the wound healing process. J Wound Care 2010;19:5-8. 10.12968/jowc.2010.19.1.46092 [PubMed] [CrossRef] [Google Scholar]
Shanmugam VK, Fernandez SJ, Evans KK, et al. Postoperatìve wound dehiscence: Predictors and associatìons. Wound Repair Regen 2015;23:184-90. 10.1111/wrr.12268 [PMC free artìcle] [PubMed] [CrossRef] [Google Scholar]
Sandy-Hodgetts K, Carville K, Leslie GD. Determining risk factors for surgical wound dehiscence: a literature review. Int Wound J 2015;12:265-75. 10.1111/iwj.12088 [PubMed] [CrossRef] [Google Scholar]
Røine E, Bjørk IT, Oyen O. Targetìng risk factors for impaired wound healing and wound complicatìons after kidney transplantatìon. Transplant Proc 2010;42:2542-6. 10.1016/j.transproceed.2010.05.162 [PubMed] [CrossRef] [Google Scholar]
Stephan RN, Munschauer CE, Kumar MS. Surgical wound infectìon in renal transplantatìon: outcome data in 102 consecutìve patìents without perioperatìve systemic antìbiotìc coverage. Arch Surg 1997;132:1315-8. [PubMed] [Google Scholar]
S0rensen LT, Hemmingsen U, Kallehave F, et al. Risk factors for tìssue and wound complicatìons in gastrointestìnal surgery. Ann Surg 2005;241:654-8. 10.1097/01.sla.0000157131.84130.12 [PMC free artìcle] [PubMed] [CrossRef] [Google Scholar]
Mahey R, Ghetla S, Rajpurohit J, et al. A prospectìve study of risk factors for abdominal wound dehiscence. International Surgery Journal 2017;4:24-8. 10.18203/2349-2902.isj20163983 [CrossRef] [Google Scholar]
Deerenberg EB, Harlaar JJ, Steyerberg EW, et al. Small bites versus large bites for closure of abdominal midline incisions (STITCH): a double-blind, multìcentre, randomised controlled trial. Lancet 2015;386:1254-60. 10.1016/S0140-6736(15)60459-7 [PubMed] [CrossRef] [Google Scholar]
Israelsson LA, Millbourn D. Preventìon of incisional hernias: how to close a midline incision. Surg Clin North Am 2013;93:1027-40. 10.1016/j.suc.2013.06.009 [PubMed] [CrossRef] [Google Scholar]
Webster C, Neumayer L, Smout R, et al. Prognostìc models of abdominal wound dehiscence after laparotomy. J Surg Res 2003;109:130-7. 10.1016/S0022-4804(02)00097-5 [PubMed] [CrossRef] [Google Scholar]
Bucknall TE, Cox PJ, Ellis H. Burst abdomen and incisional hernia: a prospectìve study of 1129 major laparotomies. Br Med J 1982;284:931-3. 10.1136/bmj.284.6320.931 [PMC free artìcle] [PubMed] [CrossRef] [Google Scholar]
Gislason H, S0reide O, Viste A. Wound complicatìons after major gastrointestìnal operatìons. The surgeon as a risk factor. Dig Surg 1999;16:512-4. 10.1159/000018778 [PubMed ] [CrossRef] [Google Scholar]