Appropriate Management of Subcutaneous Tissue of Midline Abdominal Incisions.

Nisreen Anfinan,Khalid H Sait

doi:10.7759/cureus.6549

Abstract

ObjectivesTo identify the optimal method for subcutaneous tissue management following midline abdominal incisions among patients with high thickness of subcutaneous fat (TSF).MethodsA single-center prospective controlled trial among women undergoing elective gynecologic surgery by midline incision with TSF ≥ 3 cm. Incision was managed by suture approximation of Camper’s fascia (group 1), closed suction drainage (group 2), or no intervention (control). Groups were compared for the incidence of four-week postop wound complications including surgical site infection (SSI), superficial wound dehiscence (SWD), and seroma; and baseline and perioperative factors were analyzed using multivariate regression.ResultsAmong 145 patients included (43.4% suture, 29.7% drain, 26.9% control), the overall incidence of wound complications was 15.2% (SSI 8.3%, SWD 0.7%, seroma 6.2%). The incidence of SSI was higher with suture (14.3%) versus drain (4.7%) and control (2.6%), while seroma was more frequent in drain (11.6%) versus suture (3.2%) and control (5.1%); however, both results were not statistically significant. Wound complication was independently associated with hemoglobin level (OR = 0.58, p = 0.019) and the occurrence of intraoperative complications (OR = 8.67, p = 0.048).ConclusionThere is no statistical evidence about the optimal method of wound closure in the study population. Specific risk profiles can be constructed with an emphasis on preoperative anemia and intraoperative complications.

Highlights

The development of postoperative negative outcomes as perceived either by the surgeon or by the patient, namely surgical wound complications, remained one of the significant threats to accomplish an optimal care of patients following surgeries [1]
The incidence of surgical site infection (SSI) was higher with suture (14.3%) versus drain (4.7%) and control (2.6%), while seroma was more frequent in drain (11.6%) versus suture (3.2%) and control (5.1%); both results were not statistically significant
Wound complication was independently associated with hemoglobin level (OR = 0.58, p = 0.019) and the occurrence of intraoperative complications (OR = 8.67, p = 0.048)

Summary

Introduction

The development of postoperative negative outcomes as perceived either by the surgeon or by the patient, namely surgical wound complications, remained one of the significant threats to accomplish an optimal care of patients following surgeries [1]. Wound healing impairment occurs due to infection, necrosis of wound margins or adjacent soft tissue, seroma or hematoma; all of these complications have the potential to cause wound dehiscence The latter may seem trivial, but it can be associated with devastating implications if not managed correctly. Surgeons are required to mitigate the likelihood of wound complications via controlling the potential risk factors [4] These could be related to the patient, surgical technique, or postoperative management. The success of wound healing using wound closure techniques may be challenging with increased thickness of subcutaneous fat (TSF) in obese patients [8] This is because TSF was found to be a significant predictor for surgical site infections following midline laparostomy and colorectal surgeries [9,10].

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