Wound Dehiscence and Role of Delayed Primary Closure in Gynaecological Oncology

Abstract

To study the role of delayed primary closure of the abdomen in preventing wound dehiscence in women undergoing surgery for gynaecological malignancies. Between 01 January 2017 and 30 June 2017, 22 patients underwent laparotomy at our institute. Primary closure of abdomen was done with a suction drain placed in subcutaneous space. Between 01 July 2017 and 31 December 2017, 23 patients underwent laparotomy and for those patients who had at least one of the following conditions—diabetes mellitus, obesity (subcutaneous fat > 2.5 cm), infective foci (e.g. tuboovarian abscess), delayed primary closure of the abdomen was followed. The wound was closed after a week. There were six cases of wound dehiscence in the first group. The duration of hospital stay exceeded 1 month from the day of laparotomy in all the six patients. In the second group, seven patients underwent delayed primary closure. Closure was done after a week, with a suction drain in situ. The wound healed well in all patients. All seven patients were discharged within 15 days of laparotomy. Patients with malignancy can have poor healing due to a variety of reasons. It can be due to neoadjuvant chemotherapy, previous radiotherapy, and co-morbid factors like obesity, diabetes, anaemia. Delayed primary closure involves closure of the rectus sheath following laparotomy, but the skin is closed after the blood supply to the skin and patient’s general condition have both been improved; this will certainly lead to better wound healing. It helps in reducing duration of hospital stay, treatment costs, antibiotic usage and is less frustrating for the surgeon and the patient. However, the risk of future hernia and intestinal obstruction due to post-operative adhesions remains. There are very little published data, about the benefits of delayed primary closure, but a few studies which are available do concur that this technique should be used more often. It should be practiced in those patients who are at high risk of wound dehiscence, since it reduces the duration of hospital stay, use of antibiotics, and treatment costs.