Brachioplasty after massive weight loss: analyzing wound healing and risk factors for dehiscence.

Outcomes after female cosmetic genital surgery (FCGS) performed by plastic surgeons working in a group practice setting have not been well documented. This article aimed to assess outcomes and to describe FCGS techniques used in a large group private plastic surgery practice. A retrospective chart review identified patients who underwent FCGS from 2009 to 2018. Demographic, clinical, and operative information was reviewed and recorded. Outcomes were assessed by evaluating postoperative complications and the need for revision surgery. Seventy-seven women between the ages of 14 and 53 years underwent FCGS performed by 1 of 6 surgeons. Forty-five patients underwent central wedge excision for labia minora hypertrophy, whereas 32 patients underwent extended central wedge excision for labia minora and clitoral hood hypertrophy. Four patients underwent liposuction of the mons pubis as an additional procedure. Over a mean follow-up of 37.4 months, postoperative asymmetry/redundancy occurred in 12 patients, requiring revision in 10. Wound dehiscence occurred in 12 patients, requiring revision in 9. There was one hematoma postoperatively requiring evacuation, one case of dyspareunia, and one case of decreased sensation. A single-layer wound closure (P = 0.050) and mons liposuction (P = 0.011) were risk factors for wound dehiscence. Central wedge excision and extended central wedge excision labiaplasty were the techniques used in a large group plastic surgery practice. Postoperative asymmetry and dehiscence were the most common complications, and the revision surgery rate was high. A single-layer wound closure and additional mons liposuction were risk factors for dehiscence after central wedge labiaplasty.

Skin cancer is the most common malignancy in the United States and has been increasing in incidence, affecting approximately one in five Americans. As the number of skin cancers have increased, so have the number of dermatologic procedures including biopsies and excisions. Behind surgical site infection, wound dehiscence is the second most common postoperative complication of dermatologic procedures. There are many preoperative, intraoperative, and postoperative risk factors for wound dehiscence. The current literature on the risk factors of dehiscence within the field of dermatology is scarce. To our knowledge, there have not been any comprehensive reviews on this topic. Our research article aims to serve as a comprehensive and concise review with the goal of educating providers and increasing awareness of the risk factors associated with wound dehiscence.

The perineal wound following abdominoperineal excision (APR) is associated with a high complication rate. We aimed to evaluate the risk factors for wound complications and examine the effect of flap reconstruction on wound healing. The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database was searched for patients who underwent APR for rectal adenocarcinoma. They were divided into two groups: primary closure of the perineal wound and flap reconstruction. A logistic regression analysis was performed to identify the risk factors for deep surgical site infection (SSI) and wound dehiscence. A total of 8449 (94%) patients from the database underwent primary closure and 550 (6%) underwent flap reconstruction. Patients who underwent flap reconstruction had a longer operation time, a higher incidence of deep SSI, wound dehiscence, more blood transfusion requirement and a higher rate of return to the operating room (all P<0.001). Risk factors for deep SSI were African American race (OR 1.5, P=0.02), American Society of Anesthesiologists (ASA) classification ≥4 (OR 3.2, P<0.001), body mass index (BMI) ≥35kg/m(2) (OR 1.7, P=0.006), weight loss (OR 2, P<0.001) and closure with a flap (OR 1.9, P<0.001). Risk factors for wound dehiscence included ASA classification ≥4 (OR 2.2, P=0.003), history of smoking (OR 2.2, P<0.001), history of chronic obstructive pulmonary disease (OR 1.7, P=0.03), BMI ≥35kg/m(2) (OR 1.9, P=0.001) and closure with a flap (OR 2.9, P<0.001). Perineal wound complications are related to a patient's race, ASA classification, smoking, obesity and weight loss. Compared with primary closure, closure with a flap was associated with higher odds of wound infection and dehiscence and was not protective of wound complications in the presence of other risk factors. Therefore optimizing the patient's medical condition will lead to a better outcome irrespective of the technique used for perineal wound closure.

BackgroundSeveral factors and patient characteristics influence the risk of surgical wound dehiscence and incisional hernia after midline laparotomy. The purpose of this study was to investigate whether a specified, or not specified, suture quota in the operative report affects the incidence of surgical wound complications and to describe the previously known risk factors for these complications.MethodsRetrospective data collection from medical records of all vascular procedures and laparotomies engaging the small intestines, colon and rectum performed in 2010. Patients were enrolled from four hospitals in the region Västra Götaland, Sweden. Unadjusted and adjusted Cox regression analyses were used when calculating the impact of the risk factors for surgical wound dehiscence and incisional hernia.ResultsA total of 1,621 patients were included in the study. Wound infection was a risk factor for both wound dehiscence and incisional hernia. BMI 25–30, 30–35 and >35 were risk factors for wound dehiscence and BMI 30–35 was a risk factor for incisional hernia. We did not find that documentation of the details of suture technique, regarding wound and suture length, influenced the rate of wound dehiscence or incisional hernia.ConclusionsThese results support previous findings identifying wound infection and high BMI as risk factors for both wound dehiscence and incisional hernia. Our study indicates the importance of preventive measures against wound infection and a preoperative dietary regiment could be considered as a routine worth testing for patients with high BMI planned for abdominal surgical precedures.

Pediatric postoperative abdominal wound dehiscence: transverse versus vertical incisions

Background: Postoperative wound dehiscence is a major complication following spinal metastasis surgery, particularly in patients who receive preoperative radiotherapy or molecular-targeted therapy; however, preventive strategies remain limited. Objective: In this study, we aimed to identify the risk factors for postoperative wound dehiscence and evaluate the clinical utility of a novel curved skin incision (CSI) technique, designed to avoid irradiated areas, in comparison with the conventional midline incision (MI) technique. Methods: Logistic regression analysis was conducted on 107 patients who underwent MI between 2013 and 2018. Based on the results, we developed the CSI technique. Propensity score matching was performed to compare postoperative wound dehiscence in 29 matched pairs of patients treated with either CSI or MI from 2019 to 2021. Results: Preoperative radiotherapy and molecular-targeted therapy were found to be significant risk factors for wound dehiscence. CSI, which circumvents irradiated skin, was associated with a substantially lower rate of wound dehiscence than MI. Conclusions: The CSI technique offers a simple, reproducible, and effective surgical approach to reduce postoperative wound complications in high-risk patients. Its clinical benefit, especially for those with prior radiotherapy, suggests that it may serve as a valuable addition to standard spinal metastasis surgery.

Wound dehiscence following craniotomy is a complication for which patients are subjected to additional procedures to achieve wound closure. During surgery for epilepsy, a craniotomy is performed at various sites to cure or palliate seizures in patients with intractable epilepsy. Collaborations between medicine and engineering have provided many surgical devices and materials for various stages of craniotomy, from skin incision to wound closure. The risk factors for wound dehiscence remain undetermined. Here, the authors attempt to identify risk factors associated with wound dehiscence after surgery for epilepsy. They retrospectively reviewed the clinical records and operative notes of consecutive patients with intractable epilepsy who had undergone craniotomy to allow resective or disconnective surgery between 2015 and 2023 in the Department of Neurosurgery, Hiroshima University Hospital, and had a minimum follow-up of 1 year. The authors conducted a multivariate logistic regression analysis to determine the risk factors for wound dehiscence. The study population comprised 174 patients who had undergone corpus callosotomy (70 patients), cortical resection (CR; 65 patients), or CR via intracranial video electroencephalography monitoring (IVEEG; 39 patients). Wound dehiscence occurred in 14 patients (8.0%). Univariate analysis showed that wound dehiscence was associated with CR via IVEEG (p = 0.0330), electrocautery scalpels (p = 0.0037), T-shaped skin incisions (p = 0.0216), dural closure (p = 0.0002), and longer operative duration (p = 0.0088). Multivariate logistic regression analysis revealed that skin incision using an electrocautery scalpel (p = 0.0462, OR 9.38, 95% CI 1.04-84.74) and dural closure using nonabsorbable artificial dura (p = 0.0078, OR 6.29, 95% CI 1.63-24.31) were independent risk factors for wound dehiscence. Surgical devices and materials contribute to wound dehiscence after epilepsy surgery. To avoid wound dehiscence, the use of an electrocautery scalpel is not recommended when performing skin incisions, nor is dural closure using a nonabsorbable artificial dura.

Patients with connective tissue diseases (CTD), or collagen vascular diseases, are at risk of potentially higher morbidity after surgical procedures. We aimed to investigate the complication profile in CTD versus non-CTD patients who underwent breast reconstruction on a national scale. A retrospective analysis of the Healthcare Cost and Utilization Project NIS Database between 2010 and 2014 was conducted for patients 18 years or older admitted for immediate autologous or implant breast reconstruction. Connective tissue disease was defined as systemic lupus erythematosus, rheumatoid arthritis, systemic sclerosis, scleroderma, Raynaud phenomenon, psoriatic arthritis, or sarcoidosis. Independent t test/Wilcoxon-Mann-Whitney was used to compare continuous variables and Pearson χ/Fischer exact test was used for categorical variables. Outcomes of interest were assessed using multivariable linear regressions for continuous variables and multivariable logistic regressions for categorical variables. There were 19,496 immediate autologous breast reconstruction patients, with 357 CTD and 19,139 non-CTD patients (2010-2014). The CTD patients had higher postoperative complication rates for infection (2.8% vs 0.8%, P < 0.001), wound dehiscence (1.4% vs 0.4%, P = 0.019), and bleeding (hemorrhage and hematoma) (6.7% vs 3.5%, P < 0.001). After multivariable analysis, CTD remained an independent risk factor for bleeding (odds ratio [OR], 1.568; 95% confidence interval [CI], 1.019-2.412). There were a total of 23,048 immediate implant breast reconstruction patients, with 431 CTD and 22,617 non-CTD patients (2010-2014). The CTD patients had a higher postoperative complication rate for wound dehiscence/complication (2.3% vs 0.6%, P < 0.001). They also experienced a longer length of stay (2.31 days vs 2.07 days, P < 0.001). After multivariable analysis, CTD remained an independent risk factor for wound dehiscence (OR, 4.084; 95% CI, 2.101-7.939) and increased length of stay by 0.050 days (95% CI, -0.081 to 0.181). Connective tissue disease patients who underwent autologous breast reconstruction had significantly higher infection, wound dehiscence, and bleeding rates, and those who underwent implant breast reconstruction had significantly higher wound dehiscence rates. Connective tissue diseases appear to be an independent risk factor for bleeding and wound dehiscence in autologous and implant breast reconstruction, respectively. This information may help clinicians be aware of this increased risk when determining patients for reconstruction.

Prophylactic retention sutures in midline laparotomy in high-risk patients for wound dehiscence: A randomized controlled trial

Described in the literature dehiscence rate in the adult population is 0.3-3.5%, and in the elderly group as much as 10%. In about 20-45% evisceration becomes a significant risk factor of death in the perioperative period. The aim of the study was to identify the main risk factors for abdominal wound dehiscence in the adult population. The study included patients treated in the 3rd Department of General Surgery, Jagiellonian University Collegium Medicum in Cracow in the period from January 2008 to December 2011, in which at that time laparotomy was performed and was complicated by wound dehiscence in the postoperative period. For each person in a research group, 3-4 control patient were selected. Selection criteria were corresponding age (± 2-3 years), gender, underlying disease and type of surgery performed. In 56 patients (2.9%) dehiscence occurred in the postoperative period with 25% mortality. The group consisted of 37 men and 19 women with the mean age of 66.8 ± 12.6 years. Univariate analysis showed that chronic steroids use, surgical site infection, anastomotic dehiscence/fistula in the postoperative period and damage to the gastrointestinal tract are statistically significant risk factors for dehiscence. Two first of these factors occurred to be independent risk factors in the multivariate analysis. In addition, due to the selection criteria, a group of risk factors should also include male gender, emergency operation, midline laparotomy, colorectal syrgery and elderly age (> 65 years). Logistic regression analysis did not show that a particular surgeon, time of surgery or a particular month (including holiday months) were statistically significant risk factor for dehiscence. Wound dehiscence is a serious complication with relatively small incidence but also high mortality. Preoperative identification of risk factors allows for a more informed consent before patient's treatment and to take measures to prevent or minimize the consequences of complication associated with it.

Background: Wound dehiscence, a significant postoperative complication characterized by the partial or complete separation of a surgical wound, remains a challenge despite advances in surgical techniques and perioperative care. It is associated with increased morbidity, mortality, prolonged hospital stays, and higher healthcare costs. Understanding the risk factors that predispose patients to wound dehiscence is crucial for improving surgical outcomes. Objective: The aim of this study was to identify the patient-related and surgical factors that contribute to the risk of wound dehiscence in individuals undergoing abdominal surgery, in order to inform strategies for risk reduction and management. Methods: This prospective cohort study was conducted at the General Surgery Department of Hayatabad Medical Complex, Peshawar, Pakistan, from January 2021 to January 2023. A total of 150 patients who underwent elective or emergency abdominal surgery were included. Exclusion criteria encompassed individuals undergoing obstetric or gynecological procedures and those with a prior history of wound infection or dehiscence. Data on demographic characteristics, comorbidities, type of surgery, surgical approach, and postoperative outcomes were collected. Wound dehiscence was the primary outcome, identified clinically and confirmed by surgical review. Statistical analysis involved descriptive statistics, bivariate analyses using chi-square tests, with significance set at p ≤ 0.05. Results: The mean age of the study population was 45.6 ± 12.3 years, with 60% male and 40% female participants. Comorbidities included obesity (30%), diabetes mellitus (23.3%), hypertension (16.7%), cardiovascular disease (13.3%), and smoking (20%). Elective surgeries constituted 66.7% of cases, with gastrointestinal disorders being the most common indication (46.7%). The open surgical approach was utilized in 80% of procedures. Wound dehiscence occurred in 23.4% of patients with obesity, 18.2% with diabetes mellitus, 15.6% who were smokers, 13% with hypertension, and 18.2% of advanced age. Conclusion: The study highlights obesity, diabetes mellitus, smoking, hypertension, and advanced age as significant risk factors for wound dehiscence following abdominal surgery. Addressing these modifiable factors through tailored preoperative assessment and postoperative care is essential for reducing the incidence of wound dehiscence.

The aim of this study was to determine, in a population with metastatic breast cancer treated with bevacizumab therapy, the incidence of wound dehiscence after placement of an implantable venous access device (VAD) and to study the risk of catheter thrombosis. This study enrolled all VADs placed by 14 anesthetists between 1 January 2007 and 31 December 2009: 273 VADs in patients treated with bevacizumab therapy and 4196 VADs in patients not treated with bevacizumab therapy. In the bevacizumab therapy group, 13 cases of wound dehiscence occurred in 12 patients requiring removal of the VAD (4.76%). All cases of dehiscence occurred when bevacizumab therapy was initiated less than 7 days after VAD placement. Bevacizumab therapy was initiated less than 7 days after VAD placement in 150 cases (13 of 150: 8.6%). The risk of dehiscence was the same from 0 to 7 days. In parallel, the VAD wound dehiscence rate in patients not receiving bevacizumab therapy was eight of 4197 cases (0.19%) (Fisher's test significant, P<0.001). No risk factors of dehiscence were identified: anesthetists, learning curves, and irradiated patients. VAD thrombosis occurred in four patients (1.5%). In parallel, VAD thrombosis occurred in 51 of 4197 patients (1.2%) not receiving bevacizumab therapy (Fisher's test not significant; P=0.43). Bevacizumab therapy was permanently discontinued in five patients related to wound dehiscence and in one patient due to extensive skin necrosis. These data suggest the need to observe an interval of at least 7 days between VAD placement and initiation of bevacizumab therapy to avoid the risk of a wound dehiscence requiring chest wall port explant. The risk of VAD thrombosis does not require any particular primary prevention.

Although published reports about technical management of massive weight loss patients are beginning to appear, risk factors for complications following body contouring operations are not known. A retrospective analysis of massive weight loss patients who had body contouring operations between March of 1998 and October of 2004 was performed. Demographic and surgical factors were analyzed. Outcome measures included seroma, wound dehiscence, thromboembolic complications, blood transfusion after surgery, and extended lengths of stay (>2 days). A total of 139 patients were analyzed; 82.7 percent of them were female; mean age was 41 years. On multiple logistic regression, male gender was associated with significant risks for wound dehiscence (odds ratio, 6.4; p = 0.01). There were also trends toward increased risk for wound dehiscence with hypothyroidism (odds ratio, 4.3; p = 0.06) and Ehlers-Danlos syndrome (odds ratio, 18.7; p = 0.05). In terms of risk of blood transfusion, asthma and having three or more procedures were the two variables that emerged with significant association (odds ratio, 16.8 and 13.7, respectively; both p < 0.01). Increased length of stay to greater than 2 days was also significantly associated with having three or more procedures (odds ratio, 4.72; p < 0.01). Male gender, hypothyroidism, and Ehlers-Danlos syndrome may be risk factors for wound dehiscence following body contour operations for massive weight loss. Asthma may be a marker of poor general health status, and asthmatic patients are at increased risk for requiring blood transfusions. Having three or more procedures is associated with an increased risk of blood transfusion and increased length of stay.

Background: since acute appendicitis is the most common presenting diseases in the surgical emergency departments, Appendectomy regarded as a common emergency surgical procedure that is done by the surgeons in the general surgery specialty. The complication of an incisional hernia development after open appendectomy is rare, found in about 0.12% of the appendectomy operations; interstitial type of incisional hernia complication following open appendectomy surgery is extremely rare condition, small number of reports found to deal with the incisional hernia development at the site of appendectomy in a range of (0.4-0.7%).&#x0D; Objective: To assess the incidence of incisional hernia following open appendectomy in Erbil province – Kurdistan region- Iraq.&#x0D; Patients and Methods: This retrospective study involved 598 cases between the period of first of July 2015 to 30th of April 2020, the cases presented with features of acute appendicitis, after admission and complete history taking, surgical intervention (open appendectomy) has been done for all of them, follow up for the diagnosis of the post appendectomy incisional hernia development done throughout revising the files and ID s of the patients and contacting them or their close relatives via personal mobile numbers, others re-consulted us for any operation site discomforts, any patient with suspicion of operation site problems asked to return to the outpatient surgical room for follow up and excluding or confirmation of operation site incisional hernia. The patients followed up for about 2-3 years after the operation days and contacting period with the patients or their close relatives to exclude incisional hernia development at open appendectomy site took about 6 months.&#x0D; Results: Out of 598 cases included in this retrospective study, 286 cases were male and 312 cases were female, the ages ranged between 5 and 91 years old with a mean and Standard Deviation (SD) 24.13, the age group of up to 10 years old included 13 cases, 2nd decade age group included 258 cases, while the third age group (21 – 30 years old) was included 167 cases. Risk factors for development of incisional hernia assessed among all cases, 56.85% of all cases had at least one of the risk factors and the remaining 43.15% devoid of any risk factors, the risk factors distributed among constipation (19.4%), pregnancy among female patients (18.9%), followed by diabetes mellitus, chronic cough and heavy working occupations (4.85% ,4.52% and 3.34% respectively), and BPH and anemia with other immunocompromised risk factors made only about 5.8%, only three patients (0.5%) developed incisional hernia after open appendectomy.&#x0D; Conclusion: Post open appendectomy incisional hernia is rare in patients without risk factors of wound dehiscence, with minimizing the risk factors of incisional hernia and wound dehiscence, the incidence of open appendectomy wound incisional hernia can be minimized to lowest rate.

Background: Post-laparotomy wound dehiscence is a significant complication in abdominal surgeries, characterized by the partial or complete separation of the surgical wound layers. This complication can lead to severe morbidity, extended hospital stays, and increased healthcare costs. Objective: To assess the risk factors associated with wound dehiscence in patients post-laparotomy. Methods: A cross-sectional study was conducted at the Department of Surgery from January 25, 2024, to April 25, 2024. A total of eighty patients who developed wound dehiscence following emergency or elective laparotomy were selected. Patient demographics, comorbid conditions, and clinical variables were recorded. The risk factors for wound dehiscence, including peritonitis, infection, malignancy, hypoproteinemia, and anemia, were assessed. Statistical analysis was performed using SPSS version 25, with Chi-square tests employed to assess associations between risk factors and comorbid conditions. A significance level of P ≤ 0.05 was considered statistically significant. Ethical approval was obtained, and the study adhered to the Declaration of Helsinki principles. Results: The mean age of patients was 42.67 ± 15.26 years. Males had a higher frequency of wound dehiscence compared to females. The identified risk factors included wound infection (47; 58.8%), malignancy (37; 46.2%), hypoproteinemia (35; 43.8%), anemia (30; 37.5%), and peritonitis (22; 27.5%). A significant association was found between hypertension and the risk factors of wound infection (P=0.01), malignancy (P=0.002), and hypoproteinemia (P=0.01). Conclusion: The study concluded that wound infection, malignancy, hypoproteinemia, anemia, and peritonitis are significant risk factors for wound dehiscence post-laparotomy. Hypertension showed a notable association with wound infection, hypoproteinemia, and malignancy. These findings underscore the importance of preoperative assessment and management of these risk factors to minimize the incidence of wound dehiscence.