Risk Factors and Operative Findings of Abdominal Wound Dehiscence in Emergency Laparotomy

Abstract

Introduction: Dehiscence is a partial or total separation of previously approximated wound edges, due to a failure of proper wound healing. Wound dehiscence primarily occurs after a surgery relating to an open wound. It is sometimes called wound breakdown, wound disruption, or wound separation. It can be influenced by various preoperative and postoperative factors. Various preoperative and postoperative variables might impact it, and these factors can also influence the patient's result following surgery. Aim of the Study: The aim of the study was to observe the risk factors and operative findings of abdominal wound dehiscence cases in emergency laparotomy. Methods: This prospective clinical study was conducted at the Department of Surgery, MAG Osmani Medical College, Sylhet, Bangladesh. The study duration was 8 months, from July 2008 to February 2009. A total of 460 participants were selected from those undergoing emergency laparotomy in the study place for this study. A consecutive selection method was followed for the selection of the participants. The participants were divided into two groups depending on whether wound dehiscence was developed or not. Result: All the baseline characteristics (age, body mass index, and smoking habit) of patients except sex were significantly associated with wound dehiscence. The history of receiving steroid and cytotoxic drug were higher in patients with wound dehiscence than that in patients without wound dehiscence. However, the history of receiving the immunosuppressive drug was almost identical between the groups. The patients who did not take hygienic measures or take bath before an operation or change clothing had a higher incidence of wound dehiscence. The risk factors tuberculosis, diabetes mellitus, jaundice, bronchial asthma, anemia, edema, and dehydration were found significantly higher in wound dehiscent patients compared to those without wound dehiscence. The mean duration of operation, prolene suture used for closure, midline incision, mass closure technique and drain given had significant influence on development of wound dehiscence. presence of ascitic fluid, pus and contaminated fecal material demonstrated their significant presence in patients who develop wound dehiscence than those who did not develop wound dehiscence. Postoperative conditions like abdominal distention, coughing and wound infection tend to be associated with wound dehiscence more frequently than their counterpart. Conclusion: The current study recommends evaluating patient-related risk factors before to surgery and quickly addressing them. A skilled surgeon should do surgery on high-risk patients. The study contends that the development of wound dehiscence is significantly influenced by baseline traits like age and BMI. The degree of patient cleanliness before surgery greatly influences the likelihood of wound dehiscence. According to the study, other factors that may affect the occurrence of postoperative abdominal wound dehiscence include surgical procedures, skin preparation, the length of the procedure, and the type of wound closure. Coughing, vomiting, and subsequent infection are additional postoperative side effects that increase the risk of wound dehiscence.