Abdominal Wound Closure Research Articles

Urethral obstruction due to pseudomembranous cystitis in a domestic shorthair cat

AbstractA 2‐year‐old, male, neutered, domestic shorthair cat presented with acute onset lethargy, anorexia, stranguria, dysuria without micturition. Routine blood tests demonstrated hyperkalaemia, azotaemia and metabolic acidosis. Abdominal ultrasound revealed a bi‐compartmentalised urinary bladder, with intravesical mineralised septa. The patient was diagnosed with urethral obstruction secondary to pseudomembranous cystitis. Following initial medical management, an exploratory celiotomy and cystotomy were performed, which revealed a complete fluid‐filled intravesical pseudomembranous sac, which extended via a long thin pedicle into the proximal urethra. The pseudomembranous sac was excised. Cystotomy and abdominal wound closure were routine. Post‐operative stranguria resolved with medical management within 9 days. Bacterial culture of the urinary bladder wall demonstrated no growth. Histopathology confirmed a pseudomembrane, which was composed predominantly of eosinophilic proteinaceous material and extravasated erythrocytes, with some neutrophils and cellular debris. Four months post‐operatively, no recurrence of the clinical signs has been reported.

Comparison of continuous versus modified continuous SMEAD jones “far-near-near-far” suturing technique for abdominal wall closure in emergency midline laparotomy wound in terms of wound dehiscence.

Objective: To compares the frequency of wound dehiscence in emergency midline laparotomy wound closure using the modified continuous Smead-Jones technique to the continuous method. Study Design: Randomized Controlled Trial. Setting: Department of Surgery, Allied Hospital Faisalabad. Period: December 20, 2022, to June 20, 2023. Methods: Every one of the one hundred patients having an emergency exploratory laparotomy gave written informed consent. They were split into two groups at random: Group A received continuous closure using prolene #01 suture bites placed 1 cm from the margin and 1 cm apart, and Group B received a modified Smead-Jones technique where suture bites were taken 1.5 cm from the wound margin and 0.5 cm linea alba on either side with prolene # 01 with suture placed 2cm apart. Wound dehiscence was checked following operational definitions. Results: The study's mean age was determined to be 40.18+13.53 years for Group A and 41.18+13.33 years for Group B. Males made up 58.0% (n = 29) of Group A and 72.0% (n = 36) of Group B, while females made up 42.0% (n = 21) of Group A and 28% (n = 14) of Group B. The mean wound dehiscence was 28% in Group B and 10% in Group 2. The p-value for this study was 0.022. Conclusion: When compared to the traditional continuous abdominal wound closure technique, the wound dehiscence rate was significantly lower with the modified continuous smead-jones abdominal wound closure method.

EP202 - Mesh-Mediated Fascial Traction (MMFT) and Negative Pressure Abdominal Dressing (ABTHERA): Useful in Difficult Open Abdomens?

Abstract Background Challenging abdominal surgical emergencies may require an 'Open Abdomen (OA)' as a life-saving procedure. OA has serious complications: wound infection, fluid and protein loss, catabolic state, loss of abdominal domain, and entero-atmospheric fistula. To assess the efficacy of mesh-mediated fascial traction (MMFT) & Abthera Dressing in achieving definitive abdominal closures. Patients and Method Retrospective analysis of prospectively collected data of 6 patients managed between August and November 23 in a large DGH. Following laparotomy and management of primary pathology, Abthera Dressing combined with bilateral continuous 2-0 PDS suture fixation at 0.5cm gap of macroporous Prolene (Merinium, Meril Life) meshes to each rectus sheath followed by sequential midline mesh traction closure over a time period that allowed subsequent definitive abdominal wound closure. Data collection included patient demographics (age, sex, BMI, ASA), intervention details for OA, wound characteristics, follow-up, and outcome. Results Six included M: F 4:2, age 61* (40-76 ) years, BMI 30* ( 24-35), ASA 3. Three were strangulated incisional hernia, 2 burst abdomens from faecal peritonitis, and 1 necrotizing fasciitis. Initial wound length 25*(20-32) cm, width 12.5* (4-17) cm after management of primary pathology reduced to width 4.5* (0-9) cm through MMFT and Abthera Dressing followed by definitive abdominal closure. Relook surgery required were 4* (1-9) with one full and 4 bridged mesh closures. Length of stay 39* (14-74) days. One death from respiratory failure. Conclusion The study highlights the benefit of MMFT & Abthera Dressing in achieving definitive abdominal closure for challenging OA where primary abdominal closure was not possible. * Median

Comparison of the Incidence of Surgical Site Infection in Abdominal Wound Closure: Antibiotic-Coated Polyglactin 910 Suture Versus Polyglactin Suture With Local Infiltration of Antibiotic Along the Incision Line.

Aim and objectives The purpose of this study is to compare the incidence of surgical site infection (SSI) rates in abdominal wound closure utilizing antibacterial-coated(triclosan-coated) suture material versus conventional suture material with subcutaneous antibacterial infiltration along the incision line. Materials and method This prospective and comparative (randomized, non-blinded clinical trial) was conducted at the Postgraduate Department of Surgery, Swaroop Rani Nehru Hospital, associated with Motilal Nehru Medical College, Prayagraj, India. The sample size was calculated to be one hundred. The patients in Group A underwent laparotomy using polyglactin 910 coated with triclosan. The patients in Group B underwent normal suture closure and local infiltration of broad-spectrum antibiotics (1 gram of ceftriaxone in 10 ml distilled water, along with the incision). Results There was no discernible difference between the various groups onpostoperativeday (POD) 14, 21, and 30. In Group A, 100.0% of individuals had healed wound status (POD 30). Group B had healed wound status among the 96.0% of members (POD 30). Twenty percent of the people in Group A had SSI whereas 38.0% of the participants in Group B had SSI. There was no discernible difference between the two groups regarding the distribution of culture (χ² = 7.741, p = 0.127). Conclusion Triclosan-coated sutures are more effective than subcutaneous antibiotic infiltration along the incision line in lowering the frequency of SSI during primary laparotomy wound closure.

CONTINUOUS DERMIC TRACTION WITH VESSEL-LOOP SHOELACE TECHNIQUE FOR ABDOMINAL WALL DEHISCENCE

Abstract Background The aim of this case is to highlight the importance of strict selection criteria and patient optimization for enhancing outcomes in complex abdominal wall surgery. Methods A fifty-five year-old woman, with a history of diabetes, hypertension, sigmoidectomy and grade IV obesity (BMI 42.8 kg/m2), was counseled for a midline hernia repair (M2–M4, W3). A posterior separation of components with PVDF and PP mesh placement in the retromuscular space was conducted. In the immediate postoperative period, the patient developed respiratory failure, due to abdominal compartment syndrome requiring emergent surgery with mesh removal and an open abdomen treated with Abthera® negative pressure therapy (NPT). After two months in the ICU and NPT without aponeurotic retention, the patient was transferred to our center for definitive treatment. Results The patient arrived with complete abdominal viscera exposure. While a nutritional and respiratory optimization was performed, continuous and progressive dermic traction using a vessel-loop shoelace technique and NPT were applied in order to achieve a progressive abdominal wound closure. Finally, when the skin was sufficient, a new surgery was planned to cover the exposed bowels, where only the cutaneous and subcutaneous planes could be closed. A small dehiscence in the M3 region was treated with skin grafting from the thigh. The patient has since returned home with restored quality of life. Conclusion Inadequate preoperative selection or optimization can lead to life-threatening consequences for the patient. We should promote intensive nutritional education and firmly avoid performing complex abdominal wall procedures in obese patients.

A Prospective Study on the Outcome After Mass Closure of Post-laparotomy Wound Dehiscence in a Tertiary Care Hospital, Tamil Nadu, India.

Introduction The ideal abdominal wound closure provides strength and a barrier to infection. The major cause of morbidity following any laparotomy is abdominal wound dehiscence. For prompt patient recovery and outcome factors influencing wound healing following mass closure of post-laparotomy, wound dehiscence patients are evaluated in this present study. The aim of the study was to evaluate the outcome and various complications following mass closure of post-laparotomy wound dehiscence. Materials and methods A prospective study was conducted among 50 patients admitted to the Department of General Surgery,Tamil Nadu, India, with wound dehiscence following emergency and elective laparotomy surgeries managed with mass closure during the study period from 2021 to 2022. The chi-square test and Fischer's exact test were done. Results Mass closure of post-laparotomy wound dehiscence was more common among males (74%, n=37) and less common in the age group 20-30 years (12%, n=6). Prolonged bleeding time and clotting time post-surgery were associated with the type of surgery with a significant p-value of 0.007 and 0.001, respectively, by Fischer's exact test. The presence of urine albumin was also associated with the type of surgery with a significant p-value of 0.02. Surgical site infection (postoperative complication) was associated with the type of surgery and operating time with a significant p-value of 0.004 and 0.03, respectively. Conclusion Abdominal wound dehiscence is a serious and challenging postoperative complication that necessitates immediate intervention. Strict postoperative care places emphasis on reducing the risk of wound infection and other factors related to wound dehiscence.

Abdominal wound closure in the presence of sepsis: our experience with the use of subcutaneous drain.

Patients requiring surgery for secondary peritonitis demonstrate a significantly increased risk for incisional surgical site infection. This study aimed to evaluate the efficacy of subcutaneous wound drain post-laparotomy for contaminated surgical wounds. This was a prospective comparative hospital-based study. Patients who had surgery for secondary peritonitis in Irrua Specialist Teaching Hospital were studied. Fifty patients aged 16 years and above who presented with secondary peritonitis. Patients who met the inclusion criteria were randomized into two equal groups. Group A had a suction drain placed in the subcutaneous space after laparotomy while Group B did not. Development of incisional surgical site infection, wound dehiscence, and duration of post-operative hospital stay. The incidence of incisional surgical site infection was significantly less in Group A (20%) than in Group B (68%). There was no case of wound dehiscence in Group A as against 3 (12%) in Group B. The difference was not statistically significant. The mean duration of hospital stay was significantly less with subcutaneous suction drain (8.96+2.81 Vs 14.04+8.05; p = 0.005). Subcutaneous suction drainage is beneficial in abdominal wall closure in cases of peritonitis as it significantly reduces the incidence of incisional surgical site infection and the duration of postoperative hospital stay. The reduction in surgical wound dehiscence observed in this study was, however, not statistically significant. None declared.

Routine sterile glove and instrument change at the time of abdominal wound closure to prevent surgical site infection (ChEETAh): a model-based cost-effectiveness analysis of a pragmatic, cluster-randomised trial in seven low-income and middle-income countries

Surgical site infection (SSI) is a major burden on patients and health systems. This study assessed the cost-effectiveness of routine change of sterile gloves and instruments before abdominal wall closure to prevent SSI. A decision-analytic model was built to estimate average costs and outcomes of changing gloves and instruments before abdominal wall closure compared with current practice. Clinical data were obtained from the ChEETAh trial, a multicentre, cluster-randomised trial in seven low-income and middle-income countries (LMICs), and costs were obtained from a study (KIWI) that assessed costs associated with SSIs in LMICs. Outcomes were measured as the percentage of surgeries resulting in SSIs. Costs were measured from a health-care provider perspective and were reported in 2021 US$. The economic analysis used a partially split single-country costing approach, with pooled outcomes data from all seven countries in the ChEETAh trial, and data for resource use and unit costs from India (KIWI); secondary analyses used resource use and costs from Mexico and Ghana (KIWI). In the base case, the average cost of the intervention was $259∙92 compared with $261∙10 for current practice (cost difference -$1∙18, 95% CI -4∙08 to 1∙33). In the intervention group, an estimated 17∙6% of patients had an SSI compared with 19∙7% of patients in the current practice group (absolute risk reduction 2∙10%, 95% CI 2∙07-2∙84). At all cost-effectiveness thresholds assumed ($0 to $14 000), the intervention had a higher likelihood of being cost-effective compared with current practice, indicating that the intervention was cost-effective. Similar results were obtained when the analysis using data from India was repeated using resource use and unit cost data from Mexico and Ghana. Routine sterile glove and instrument change before abdominal wall closure is effective and the costs are similar to those for current practice. Routine change of gloves and instruments before abdominal wall closure should be rolled out in LMICs. National Institute for Health and Care Research (NIHR) Clinician Scientist Award, NIHR Global Health Research Unit Grant, and Mölnlycke Healthcare.

Comparative Study of Use of Reusable Skin Staples and Vertical Mattress Sutures in the Closure of Midline Laparotomy Wounds.

There is an increasing tendency to close midline abdominal wounds with staples because of the speed of closure. The aim of this study was to compare the use of skin staples and vertical mattress sutures in the closure of midline abdominal wounds. Patients who met inclusion criteria and were booked for laparotomy in our teaching hospital were counseled on the two methods of skin closure using vertical mattress sutures or the use of staples (35 W Surustap, Suru International PVT Ltd, India). Alternating post-laparotomy wounds were closed using skin staples and with a vertical mattress, using nylon 2(0) (3 metric) sutures. The parameters assessed were speed of closure, cost of closure using the different methods, wound infection rate, and short-term cosmetic appearance of wounds. Data were analyzed using SPSS version 21 (IBM, SPSS, Chicago, Illinois). Sixty patients met the inclusion criteria and were recruited for the study. The speed of closure of midline laparotomy skin wound was significantly higher in "the staple group" than in "the suture group" (0.14 vs. 0.034 cm/s), P < 0.05, while the cost of use of staples was significantly more than the cost for closure with sutures (184 vs. 26 Naira/cm), P < 0.05. The mean operative time was significantly less in "the staple group" than in "the suture group" (128.9 minutes versus 157.6 min), P < 0.05. There was no significant difference in the infection rates and cosmetic appearance between the two groups (P > 0.05). Midline abdominal wound closure with staples is faster. There was no difference in wound complication rates and scar appearance when compared with skin closures using the vertical mattress technique. Wound closure with staples is, however, more costly.

A Comparison of a Small-Stitch Closure With a Standard Closure in Midline Laparotomy Incisions: A Prospective Comparative Study.

Introduction Midline incision provides a rapid and thorough approach to the abdominal cavity and, therefore, is widely employed in both emergency and elective procedures. However, midline laparotomy is associated with many post-operative complications likewound dehiscence, incisional hernia, fistula formation, and surgical site infection (SSI). The purpose of the study is to comparethe complications that occurred post-operativelyin associationwith thelong and smallbite suture techniques for midline laparotomy incisions. Methodology A prospective comparative study was carried out among 90 cases of midline laparotomies for 18 months (January 2021 to June 2022). The participants were categorizedinto two groups: (1) Group A, which included 45 patients, underwent small-suture abdominal fascia closure, and (2) Group B, which consisted of the remaining45 patients, underwent large-suture abdominal midline wound closure. Patients were followed up in the hospital till the day of discharge and in the outpatient department (visit 1, within one month of surgery) for pain, wound dehiscence, and surgical site infection. Patients were called for visit 2 (six months post-surgery) and incisional hernia rates were assessed. Results On the numerical pain rating scale, the mean score was higher in Group B, that is, 4.1 than in Group A, which was 3.5. Wound dehiscence and incisional hernia rates were higher among Group B cases. The majority of SSIs were noted in Group B with statistically significant results. Conclusion Despite the lack of randomization,the results demonstrated in this study support the use of small bite sutures in comparison to long bite sutures for laparotomy closure.

Routine Sterile Glove and Instrument Change at the Time of Abdominal Wound Closure to Prevent Surgical Site Infection: Reviewing the ChEETAh Trial.

"Evidence-Based Reviews in Surgery" (EBRS) was developed to foster critical appraisal skills in practicing surgeons and trainees in order that they may evaluate surgical literature and practice Evidence-based Based Surgery. EBRS virtually connects experts in clinical surgery and evidence-based methodology to collaboratively assess the strengths and weaknesses of current practice compared to the risks and benefits of new approaches to care. Since the inception of EBRS, summaries of each review have been published. The present article is a comprehensive review of the ChEETAh trial, investigating the effectiveness of routine glove and instrument change before abdominal wound closure to prevent surgical site infection (SSI). The trial was conducted in low- and middle-income countries (LMICs) and employed a cluster-randomized design. The results indicate a statistically significant reduction in SSI rates. Although the ChEETAh trial has strengths, caution is advised before implementing the intervention globally. The study's clinical relevance and cost-effectiveness need to be considered, and targeted implementation in specific patient clusters and hospitals with the necessary resources is recommended. Institutions should not only assess their unique circumstances (resources, baseline SSI rates, and use of other effective preventive measures) before implementing glove and instrument changes in their setting but also monitor their outcomes and costs should they choose in favor of implementation. Further research, including long-term effects, is suggested to refine the understanding of the intervention's implications in diverse settings.

Comparing clinical outcomes between patients receiving non-absorbable and delayed absorbable sutures for abdominal wound closure after laparotomy

Background: There is a lot of debate about the best suture for repairing the abdominal fascia post-laparotomy. This research compared the clinical results of patients who received non-absorbable versus delayed absorbable sutures for abdominal wound closure after laparotomy. Methods: We conducted a prospective non-randomized clinical trial in the Department of General Surgery, Janaki Medical College and Teaching Hospital, Janakpur, Nepal. We included patients aged more than 18 years who underwent an elective laparotomy surgery with midline vertical incision for any indication between April 2020 till March 2022 in our department. Two study groups were formed: non-absorbable suture (polypropylene suture) and delayed absorbable suture (polydiaxanone suture). Results: The two study groups were similar with respect to indication of surgery (p value = 0.52). Bowel was opened in 81% in non-absorbable group and in 85% in delayed absorbable suture group. Mean duration of surgery was found to be significantly lower in the delayed absorbable suture group as compared to non-absorbable suture group (185±21.8 vs. 232±27.3 minutes, p value &lt; 0.05). Post-operative complications included surgical site infection, burst abdomen, incisional hernia and sinus formation. It was observed that surgical site infection rate was significantly higher among non-absorbable suture group patients as compared to delayed absorbable suture group (25% vs. 13%, p value &lt;0.05). Conclusions: Comparing early and late post-operative complications, there was no statistically significant difference between non-absorbable suture group and delayed absorbable suture group.

Does the routine skin only closure in ruptured Abdominal Aortic Aneurysm repair safely diminish abdominal compartment syndrome? A hypothesis generating retrospective study.

Abdominal compartment syndrome (ACS) often complicates ruptured abdominal aortic aneurysm (rAAA) repair. We aim to report results with routine skin-only abdominal wound closure after rAAA surgical repair. Single center, retrospective study including consecutive patients undergoing rAAA surgical repair during 7-years. Skin-only closure was routinely performed and if possible, secondary abdominal closure was performed during the same admission. Demographic information, preoperative hemodynamic condition of patients, perioperative information such as ACS, mortality and rate of abdominal closure and postoperative information were collected. During the study period 93 rAAAs were recorded. Ten patients were too frail to undergo repair or refused treatment. Eighty-three patients underwent immediate surgical repair. Mean age was 72.4±10.5 years and the vast majority were male (82:1). Preoperative systolic blood pressure <90mmHg was recorded in 31 patients. Intra-operative mortality was recorded in 9 cases. Overall in-hospital mortality was 34.9% (29/83). Primary fascial closure was performed in 5 patients, while skin-only closure was performed in 69. ACS was recorded in two cases in whom skin sutures were removed and negative pressure wound treatment was applied. Secondary fascial closure was feasible in 30 patients during the same admission. Among 37 patients not undergoing fascial closure, 18 died and 19 survived and were discharged with a planned ventral hernia. Median length of ICU and hospital stay were 5(1-24) and 13(8-35) days, respectively. After a mean follow-up of 21 months, telephone contact was possible with 14/19 patients that left the hospital with an abdominal hernia. Three reported hernia-related complications mandating surgical repair, while in 11 this was well tolerated. Routine skin-only closure during rAAA surgical repair results in low rates of ACS at the expense of a high rate of patients being discharged with a planned ventral hernia which, however, seems to be well tolerated by the majority of patients.

Strategies to minimise and monitor biases and imbalances by arm in surgical cluster randomised trials: evidence from ChEETAh, a trial in seven low- and middle-income countries

BackgroundCluster randomised controlled trials (cRCT) present challenges regarding risks of bias and chance imbalances by arm. This paper reports strategies to minimise and monitor biases and imbalances in the ChEETAh cRCT.MethodsChEETAh was an international cRCT (hospitals as clusters) evaluating whether changing sterile gloves and instruments prior to abdominal wound closure reduces surgical site infection at 30 days postoperative. ChEETAh planned to recruit 12,800 consecutive patients from 64 hospitals in seven low-middle income countries. Eight strategies to minimise and monitor bias were pre-specified: (1) minimum of 4 hospitals per country; (2) pre-randomisation identification of units of exposure (operating theatres, lists, teams or sessions) within clusters; (3) minimisation of randomisation by country and hospital type; (4) site training delivered after randomisation; (5) dedicated ‘warm-up week’ to train teams; (6) trial specific sticker and patient register to monitor consecutive patient identification; (7) monitoring characteristics of patients and units of exposure; and (8) low-burden outcome-assessment.ResultsThis analysis includes 10,686 patients from 70 clusters. The results aligned to the eight strategies were (1) 6 out of 7 countries included ≥ 4 hospitals; (2) 87.1% (61/70) of hospitals maintained their planned operating theatres (82% [27/33] and 92% [34/37] in the intervention and control arms); (3) minimisation maintained balance of key factors in both arms; (4) post-randomisation training was conducted for all hospitals; (5) the ‘warm-up week’ was conducted at all sites, and feedback used to refine processes; (6) the sticker and trial register were maintained, with an overall inclusion of 98.1% (10,686/10,894) of eligible patients; (7) monitoring allowed swift identification of problems in patient inclusion and key patient characteristics were reported: malignancy (20.3% intervention vs 12.6% control), midline incisions (68.4% vs 58.9%) and elective surgery (52.4% vs 42.6%); and (8) 0.4% (41/9187) of patients refused consent for outcome assessment.ConclusioncRCTs in surgery have several potential sources of bias that include varying units of exposure and the need for consecutive inclusion of all eligible patients across complex settings. We report a system that monitored and minimised the risks of bias and imbalances by arm, with important lessons for future cRCTs within hospitals.

COMPARATIVE STUDY OF SKIN STAPLES AND CONVENTIONAL SUTURES FOR ABDOMINAL SKIN WOUND CLOSURES

Introduction : The ideal abdominal wound closure provides strength and a barrier to infection. In addition, the closure should be efcient, performed without tension or ischemia, comfortable for the patient, and aesthetic. Present study aimed to compare skin staples with conventional suturing for abdominal skin closure. Material and Method: This comparative observational study was conducted among the patients coming to Department of General Surgery, Aarupadai Veedu Medical College and Hospital, undergoing elective abdominal surgery who were willing to participate in the study by giving informed and written consent. Patients were grouped based on type of skin closure done, group Aare patients with skin staples in elective abdominal surgery and group B are the patients with conventional suture method of skin closure in elective abdominal surgery. Both the group were assessed for the duration of skin closure, the outcome of wound assessed using ASEPSIS score on 3rd, 5th and 7th post-operative day and wound Cosmesis was assessed using Modied Hollander Cosmesis scale on 7th day, after 2 weeks, 6 weeks and on 3rd month of wound healing. All the statistical analysis were analysed using SPSS v21 operating on windows 10. Results: In our study total 120 patients undergoing elective abdominal surgeries were included with 60 patients in each group. The mean age and gender distribution between both groups was found to be similar with no signicant difference. On comparison of number of staples and number of sutures used, it was signicantly higher in staple group than suture group (p&lt;0.05). On comparison of duration of closure it was signicantly lower in staple group than in suture group ( p&lt;0.05). ASEPSIS score at different point of follow-up showed there is signicantly lower mean score among patients in staple group compared to suture group (p&lt;0.05). On comparing wound score using Modied Hollander Cosmesis scale, the mean score was signicantly higher in staple group than in suture group (p&lt; 0.05). The complications at different point of follow- up was also signicantly lower in staple group than suture group (p&lt;0.05). The degree of patient satisfaction was also signicantly higher in stapler group than in suture group. Conclusion: The present study documented a signicant better outcome in patients who underwent skin closures with staples than with conventional sutures in view of duration of closure, ASESPSIS score, Modied Hollander Cosmesis score, complications and patient satisfaction.

An international assessment of surgeon practices in abdominal wound closure and surgical site infection prevention by the European Society for Coloproctology.

The burden of abdominal wound failure can be profound. Recent clinical guidelines have highlighted the heterogeneity of laparotomy closure techniques. The aim of this study was to investigate current midline closure techniques and practices for prevention of surgical site infection (SSI). An online survey was distributed in 2021 among the membership of the European Society of Coloproctology and its partner societies. Surgeons were asked to provide information on how they would close the abdominal wall in three specific clinical scenarios and on SSI prevention practices. A total of 561 consultants and trainee surgeons participated in the survey, mainly from Europe (n= 375, 66.8%). Of these, 60.6% identified themselves as colorectal surgeons and 39.4% as general surgeons. The majority used polydioxanone for fascial closure, with small bite techniques predominating in clean-contaminated cases (74.5%, n= 418). No significant differences were found between consultants and trainee surgeons. For SSI prevention, more surgeons preferred the use of mechanical bowel preparation (MBP) alone over MBP and oral antibiotics combined. Most surgeons preferred 2% alcoholic chlorhexidine (68.4%) or aqueous povidone-iodine (61.1%) for skin preparation. The majority did not use triclosan-coated sutures (73.3%) or preoperative warming of the wound site (78.5%), irrespective of level of training or European/non-European practice. Abdominal wound closure technique and SSI prevention strategies vary widely between surgeons. There is little evidence of a risk-stratified approach to wound closure materials or techniques, with most surgeons using the same strategy for all patient scenarios. Harmonization of practice and the limitation of outlying techniques might result in better outcomes for patients and provide a stable platform for the introduction and evaluation of further potential improvements.

Spotlight in Plastic Surgery: April 2023.

Spotlight in Plastic Surgery: April 2023.

INCIDENCE OF SURGICAL SITE INFECTION/ WOUND GAPING IN SUTURED VS STAPLED CLOSURE OF ABDOMINAL INCISION: A COMPARATIVE STUDY

Background Surgical wound is any wound inicted during surgical process and infection of surgical wound is a relevant complication with an incidence of 1% to 3%. Many factors are responsible for the occurrence of surgical site infections, like age, presence of comorbidities, type of procedure, wound closure method, level of contamination etc. Surgical Site Infection or SSI is associated with a signicant economic burden in terms of extended length of stay and increased costs of treatment. Objectives- To determine whether the incidence of surgical site infections differed after wound closure with non-absorbable suture material vs skin stapler, in elective abdominal surgeries. Methods- A comparative study to determine the incidence of surgical site infections after elective abdominal surgery was conducted in a tertiary care setup for a duration of one year. The study population was divided by random computer method in two arms, consisting of 30 patients each. In one arm the abdominal wound after elective surgery was closed with non-absorbable sutures while in the other with skin staplers. Outcomes were noted in terms of Surgical site infection, i.e, presence of wound gape, burst abdomen, closure duration, duration of hospital stay and interventions like secondary suturing, daily cleaning and dressing (CnD) Results- A total of 60 patients who underwent elective abdominal surgeries were divided into two arms of 30 patients each. Wound closure in one group done by non-absorbable suture material while in the other group with skin stapler. The groups were comparable in demographics, ASA (American society of Anaesthesiologist) grading and CDC (Centre for disease control) class of surgical wound. In our study, Surgical site infections were detected in 33.3 % (10 patients) in the sutured arm of closure of abdominal incision, while SSI were detected in 26.6 % (8 patients) of stapled arm of closure of abdominal incision. No signicant difference encountered in the incidence of SSI in sutured and stapled closure of abdominal wound. 76.7% (23 patients) underwent wound closure within 10 minutes in the stapled arm, while only 20 % (6 patients) in the sutured arm had surgical time duration of wound closure less than 10 minutes (p value &lt; 0.001), the wound closure duration in the stapled arm was signicantly less compared to the sutured arm. Conclusions- There was no signicant difference in the incidence of surgical site infections in both the groups, but the surgical time duration of wound closure was signicantly lower in the stapled group.

A262 NEONATAL ACUTE LIVER FAILURE DUE TO PRESUMED GESTATIONAL ALLOIMMUNE LIVER DISEASE - A CASE REPORT

Abstract Background Neonatal acute liver failure (NALF) is a rare disease that is distinct from acute liver failure seen in older children and adults. Gestational alloimmune liver disease (GALD) is the most frequent cause, is initiated in utero by sensitization of the maternal immune system to a fetal hepatocyte antigen and subsequent production of maternal immunoglobulin G antibodies that cross the placenta. Maternal IgG binds to a fetal hepatocyte antigen and initiates an innate immune response involving the terminal complement cascade and membrane attach complex. The understanding of the alloimmune origin has led to the use of intravenous immunoglobulin (IVIG) treatment and exchange transfusion, significantly increasing survival. However, approximately 25% of patients may not respond and require salvage liver transplantation. In spite of an increased rate of comorbidities, concern for technical difficulties and limited graft availability, young infants eligible for transplant have been shown to have similar overall patient and graft survival rates compared to older children with other indications for liver transplant. Purpose The primary aim of our study is to report a case of NALF with successful liver transplant. Method We present the case of a preterm girl with NALF due to GALD refractory to medical management, requiring liver transplantation. Result(s) This is a 35-week preterm girl, with scant pre-natal care, birth weight of 1.825 kg and Apgar 9/9. She is the seventh child of non-consanguineous parents, with healthy siblings. On day-of-life (DOL) 1 she presented with acute kidney injury, progressive worsening metabolic acidosis and hyperammonemia and was found to be profoundly coagulopathic (INR 6), with normal liver enzymes and liver failure was diagnosed. Initial investigation ruled out congenital infections, sepsis, neonatal hemophagocytic lymphohistiocytosis and metabolic diseases. Magnetic resonance imaging of the body demonstrated findings in keeping with iron deposition in the thyroid, liver and pancreas, suggestive of GALD. Completed double volume exchange transfusion and IVIG on DOL 9 and repeat IVIG on DOL 13 and 15, with partial improvement in INR. Due to persistent ascites, conjugated hyperbilirubinemia and hyperammonemia she was transferred for urgent liver transplant assessment. Persistent liver dysfunction in the form of hyperammonemia, hypoglycemia and progressive coagulopathy led to transplant listing on DOL 30. ABO incompatible deceased donor liver transplant was completed on DOL 62 (4.075 kg, estimated dry weight 3.5 kg). The procedure was uncomplicated, liver enzymes normalized, coagulopathy and hypoglycemia resolved. She was transferred to the ward on post-operative day (POD) 6. and weaned off sedatives and transitioned to oral feeds within 2 weeks of transplant, with complex abdominal wound closure on POD 29. Conclusion(s) Successful liver transplantation is possible in neonates with acute liver failure due to GALD refractory to medical management and weighing 4kg or less. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest None Declared MICROBIOME &amp; MICROBIAL THERAPY

Effect of Suture Length on the Incidence of Incisional Hernia and Surgical Site Infection in Patients Undergoing Midline Laparotomy: A Systematic Review and Meta-Analysis.

The development of an incisional hernia is a common complication of midline laparotomy. Improper fascial closure techniques have a significant role in its development. It can also lead to poor wound healing and increase the risk of developing surgical site infections (SSI). Upon conducting a thorough literature review, various studies have been conducted on closing abdominal wounds. However, there is a dearth of studies portraying the role of suture length in the prevention of incisional hernia and SSI. The effect of using a greater suture-to-wound length ratio on postoperative outcomes was not clearly analyzed or described. The objective of this study is to assess the effectiveness of using a suture length to wound length ratio ≥4:1 versus a ratio <4:1 in preventing postoperative complications such as incisional hernia and SSI. This study is a systematic review of randomized controlled trialson abdominal wound closure using a suture length to wound length ratio of≥4:1 and <4:1. published in PubMed, Google Scholar, and Cochrane library. The inclusion and exclusion criteria were defined. The relevant studies identified from 1991 to 2017, were included in the analysis. The primary endpoint was the incidence of incisional hernia, and the secondary outcome was the incidence of SSI. This meta-analysis considered five randomized controlled trials that compared the effects of using different suture lengthto wound length ratios during abdominal closure on incisional hernia and SSI. Participants ranged in size from 100 to 363. The trial follow-up period ranged from a minimum of 10 months to five years. The outcomes studied in the two groups were incisional hernia and SSI. The relative risk of the occurrence of incisional hernia if the suture length to wound length ratio was ≥4:1 was 0.42 with a p-value of <0.001 which was considered significant. This implied that usinga suture length of more than four times that of the wound i.e., 4:1, significantly decreases the risk of developing an incisional hernia by more than half. The relative risk of developing a SSI was 0.98 with a p-value of 0.966. Thus, this method of abdominal closure uing a longer suture length to wound length ratio does not contribute to an increased incidence or significant change in the risk of developing SSI.