Abdominal Wound Closure Research Articles

A 2-year Review of Wound Outcome Following Primary Skin Closure After Laparotomy for Typhoid Ileal Perforation in Bida, Nigeria

Introduction: Laparotomy wound for typhoid ileal perforation is a dirty wound and is usually associated with wound complications and prolonged hospital stay. Delayed primary wound closure which for long has been the most common practice after laparotomy for typhoid peritonitis is now considered to be of little significance in preventing surgical site infection (SSI). We aimed to document the incidence, severity and management of wound complications when primary closure of abdominal wounds was performed following laparotomy for typhoid ileal perforation. Patients and Methods: This was a retrospective study of all patients who had primary abdominal wound closure following laparotomy for typhoid ileal perforation in Federal Medical Centre, Bida from January 2017 to December 2018. Results: There were 71 patients with the age ranges from 2 to 41 years and their median age was 15 years who had laparotomy for typhoid ileal perforation during the study period. All 71 patients had primary closure of their abdominal wounds, however two of them died within 72 hours of operation and were excluded from the study. There were males 38 (55.1%) and females 31 (44.9%) with a male to female ratio of 1.2:1. There was primary wound healing in 23 (33.3%) patients while 44 (63.8%) of them developed incisional surgical site infections (SSI) and 2 (2.9%) developed organ space SSI. Of the 44 patients that had incisional SSI, 33 (75.0%) were superficial and 11 (25.0%) were deep. Other complications noted from the study were faecal fistulae 3 (4.3%) and incisional hernia (4.3%). Conclusion: Though a high incidence of wound morbidity is not unexpected in situation of primary closure of laparotomy wound for bacteria peritonitis, an aggressive wound management may help to reduce the incidence and severity of wound complications in such situations.

Temporary Abdominal Closure Technique After Pediatric Liver Transplant: Single-Center Experience.

Primary abdominal wound closure is performed at the completion of liver transplant in most patients. However, this is not always possible in pediatric recipients. The shortage of size-matched donor organs for pediatric patients means that occasionally it is necessary to use whole livers that are larger than can be accommodated comfortably in the child's abdomen. The present report outlines our experience with temporary patch closure after pediatric liver transplant of the abdominal wall. Our team performed the first liver transplant in Turkey in 1988. Since 1988, we have performed 629 liver transplant (336 adult and 293 pediatric) procedures at our center. We evaluated data of 191 liver transplants performed in recipients who were under 10 years of age. Left lateral lobe grafts were used in 169 patients (88%), and whole grafts were used in 22 patients (12%). Temporary closure with the Bogota bag patch was necessary in 31 transplant procedures (16.2%), 3 of which involved whole livers and 28 of which involved left lateral lobe grafts. The age range of recipients was 5 months to 10 years (median, 30 mo). The temporary abdominal closure technique was preferred in 22 patients because the abdomen could not be closed during surgery. In pediatric patients with difficult abdominal closure after liver transplant, temporary patch closure is the treatment of choice. Our preference has been reinforced silicone sheeting, which allows minimal adhesion formation between the patch and abdominal viscera; in addition, the transparent nature of the material provides a window for inspection of the donor liver.

A study of comparison between skin sutures and skin staplers

Wound closure is as important as any other action performed by the surgeon. Apart from the need for producing a healthy and strong scar, it is the surgeon’s responsibility to ensure its aesthetically pleasing physical appearance. Skin staples are an alternative to regular sutures in offering this advantage. The present study has helped to highlight the comparison between skin sutures and skin staplers. The skin stapling devices have revolutionized surgery for the purpose of rapid closure of abdominal wounds. However, staples have their own drawbacks. In view of this, this prospective study has been undertaken to highlight the outcomes of closure by staples and sutures with respect to speed of closure, cost effectiveness and post operative wound dehiscence, acceptance of scar and post operative pain. This is a prospective hospital based study conducted in our hospital from January 2017 to December 2018 at S.V.S Medical College. 200 patients who underwent various surgical procedures. Results were analyzed and compared with previous studies. It has been found that the use of staples in abdominal surgical wound closure gives faster speed of closure, less postoperative pain, and better cosmetic results. Staples, however, are costlier, and when used in emergency cases, associated with higher rates of wound dehiscence and a less acceptable scar.

Usage of full-thickness Keystone flap procedure in anterior abdominal wall reconstruction (case report)

The postoperative eventration is one of the severe complications of abdominal oncological surgery, which complicates of postoperative course and leads to long‑term inpatient treatment, repeated surgery and forming laparostoma, filled with hypertrophic granulations. In spite of the numerous of surgical methods proposed for anterior abdominal wall wound closure in such patients, the anterior abdominal wall reconstructive operations keep to stay the difficult and unresolved challenge for abdominal surgery.The aim — to improve the outcomes of surgical treatment of severe patients with postoperative anterior abdominal wall defects (eventration) with full‑thickness Keystone flap procedure.The case report of the closing of anterior abdominal wall defect after chemotherapy complicated by intestinal bleeding, perforation, peritonitis, repeated operations has described in the article. The possibility of the successful multimodal reconstruction of anterior abdominal wall defects in oncology patient with using perforating vessels flap has demonstrated in the case report. The identification of perforating vessels with satisfactory tissue perfusion of Keystone flap with using of combine method (infrared thermometry and Doppler velocimetry) had been conducted in the preoperative period. The surgical debridement of the anterior abdominal wall, wound cavitation with low‑frequent ultrasound, wound closure with Keystone flap had been performed as the first stage of treatment. The midline laparotomy, the adhesiolysis, the sanitation and drainage of intestinal interloop abscesses, the right‑side hemicolectomy had been conducted as the second treatment step. The third stage of the surgery was closing of the midline laparostoma by means of the repeated surgical debridements of the anterior abdominal wall wound, the wound plastic with Keystone flap formed from the soft tissue of chest anterior wall.Conclusions. The successful closure of anterior abdominal wall eventration with forming laparostoma filled by hypertrophic granulations must be based on dynamic control approach of soft tissue perfusion of anterior abdominal wall.

Abdominal Wound Closure in Gynaecological or Obstetrical Surgery with Vicryl® (Polyglactin910) Versus Vicryl Plus® (Polyglactin910 with Triclosan Added): A Comparative Study

Background: Surgical site infection is the most common post-surgical complication in surgical patients. The incidence of surgical site infection varies from 3-20% (or even more) in different part of the world. To date, the best method and material for skin closure has not been recommended by anybody. Triclosan is an antiseptic agent used for coating a suture material to prevent the infections. This case-controlled study was carried out to determine the comparative efficacy of sutures;
 Objective: This case-controlled study was carried out to determine the comparative efficacy of sutures: vicryl® and vicryl plus® (triclosan, an antiseptic incorporated with suture), in reducing surgical site infection in laparotomy for clean Gyn/Obs operations.
 Material and method: This case-controlled study was carried out in Dept. Of Gynae/Obs at Nepalgunj Medical College Teaching Hospital, Kohalpur. The period of the study was from Jan 2018 to January 2019. A total of 50 participants were enrolled in the study, who met the inclusion criteria. The patients were divided into two groups A and B, each consisting of 25 patients. The patients were allocated in the groups alternately to remove bias. The Group A consisted of patients where Vicrylplus® (Ethicon, Johnson & Johnson Company, Ahmadabad, India) polyglactin910 with triclosan) was used and Group B consisted of patients where vicryl ® (Ethicon, Johnson & Johnson Company, Ahmadabad, India) polyglactin910 alone) was used. Patients whose abdominal wounds were found infected, pus swab for culture were taken and sent for aerobic culture and sensitivity. All patients received ceftriaxone and metronidazole single dose before operations prophylactically.
 Result: Surgical site infection ingroup A was 3 cases out of 25 (12%) and in group B it was 6 cases out of 25(24%). Triclosan added polyglactin910 suture found to be statistically non significant concerning prevention of SSI as compared to polyglactin910 (p=0.472). The mean age of the study population was in group A was (29.76±7.47) and in group B was (27.12±7.42).

Study of incisional hernia

Background: Incisional Hernias are common complication of abdominal surgery. Depending on the risk factors Incisional Hernia can occurs in 12 - 30 % of patients subjected to abdominal operations. Aims and Objective: A clinical study on risk factors, clinical presentations, management and post-operative complications in patient with Incisional Hernia. Material and Methods: A total of 54 patients of Incisional Hernia were studied and postoperative complications were evaluated in our institute. Results: Incidence of incisional hernia is more common in females than males and the overall M: F ratio is 1:2. Incisional hernia incidence is high in lower abdominal incisions. Conclusions: Closure of abdominal wound in layers and prevention of wound infection reduces chances of incisional hernia.

A comparative study of skin staples and conventional sutures for abdominal skin wound closures

Background: The objectives of the study were to study the operative time, the effect on wound healing, cosmetic results, patients acceptance and total cost with the use of sutures and staples.Methods: The study was conducted on 100 patients who were undergoing elective surgery from January 2016 to July 2017 in our institute. The patients were randomly selected to receive either suture or staple.Results: The study group included 50 patients who underwent wound closure by staplers and 50 patients underwent suturing. The commonest region of the surgical wounds was Mc Burneys site. The time taken for wound closure using staplers showed statistically significance difference over closure with suture, it took the stapler 4 times less duration to perform wound closure. The average cost of using stapler was higher than suturing. The appearance of the scar among the staple group was good in 90% of those who returned for follow-up at 1 month, 10% had average scar. The patients acceptance was better in staple group with less pain during removal as compared to suture group. P-value calculated using students unpaired T-test. P<0.0001 which was highly significant.Conclusions: Staples did not cause excess wound pain and allows saving in time with better cosmetic results.

A prospective study of single layer abdominal wall closure in the tertiary care hospital

Background: Despite advances in surgical techniques and material, abdominal wound closure remains challenging. Most abdominal wall incisions are either midline or paramedian. The value of a particular method of closing is determined by the incidence of early and late wound complications. The best abdominal wound closure technique should be, fast, easy, safe and cost effective. It should also prevent or minimize the early and late complications. This study addresses the midline single-layer closure of the abdominal wound.Methods: The purpose of this study is to evaluate the single layer midline abdominal wound closure. The early and late complications associated with this method are studied, and relevant literature reviewed. The study period is from May 2016 to May 2018, i.e. 24 months. The study group comprises of 52 patients, admitted in the department of surgery SBRKM Government medical college Jagdalpur. In all of them, the midline incisions closed in a single layer by a non-absorbable continuous suture. The skin closed separately. The mean age of the patient is 46.5 years. The male to female ratio is 3:1. Emergency laparotomy done in 35 cases and 17 (38.4%) underwent elective surgeries.Results: In this series 20 (38.4%) patients had wound infection. 10 (19.2%) patients had wound gaping. There was no incisional hernia in six months follow-up.Conclusions: Single layer abdominal wall closure has a definite advantage. It is fast, easy and cost-effective. Continuous running suture with non-absorbable material provides enough strength during healing and is better than interrupted sutures. The incidence of early and late complications is also significantly less. The results are comparable to many meta-analyses and RCT did in this field.

Koch's abdomen- management of surgical complications and outcomes at a remote hill area tertiary care center

Background: Abdominal tuberculosis needs surgical intervention in a subset of patients; both in emergency and elective settings, requiring surgeons to be familiar with its varied and non-specific modes of presentation and their diagnosis and management.Methods: Patients of abdominal tuberculosis, having undergone surgical management at our Institute, VCSGGMS&RI-UT, between April 2015 to March 2019, numbering eighty (n= 80), were included in this concurrent observational study.Results: Middle age-group patients (20-50 years; 56.3%) with a male majority (73.8%) predominated. Reinfection/ relapse of tuberculosis infection might occur despite BCG immunisation (46.3%) and course of ATT (16.3%); complications like bowel obstruction (28; 35%), perforation etc. need laparotomy to effect relief, with stomy formation required (51.3%) frequently; inadequate recovery warranting a secondary/re-look laparotomy (15; 18.8%). Prolene suture for abdominal wound closure is advantageous with a lesser rate of complications and incisional hernia. Septicemia, multi-organ dysfunction, wound infection should be aggressively managed to prevent adverse outcomes, including death (10; 12.5%).Conclusions: Adequate, intensive and timely surgical intervention/laparotomy, with nutritional support, stomy care and concurrent ATT can result in prompt relief and speedy recovery of patients with abdominal tuberculosis.

A prospective study on incisional hernia, its incidence, etiology and management in a tertiary care hospital of Odisha

Background: Incisional hernia (IH) is defined as the hernia protruding through incompletely healed abdominal surgical wound. Management of IH can be preventive (avoidance of infection and suture line tension, proper abdominal wound closure) or operative (anatomical reconstruction or repair with synthetic non-absorbable mesh either by open or laparoscopy method).Methods: A descriptive prospective observational study on 51 patients with age >15 yrs was conducted in the Department of General Surgery, SCB Medical College and Hospital, Cuttack from August 2015 to August 2017. Diagnosis was made with clinical history, physical examination, X-ray abdomen and USG abdomen. The patients underwent different surgical procedures depending on size of defect, patient’s consent and expertise available. Post-operative complications were noted and patients were followed up to 1 year for any recurrence.Results: 28 males and 23 females were included. The mean age was 42.3 years. Most common cause of IH was post-operative wound infection (47.1%). Maximum cases were following emergency surgery (88.2%). Midline incision contributes maximum number (52.9%) followed by Pfannenstiel incision (25.4%). Open hernioplasty was the most common procedure (58.8%) followed by anatomical repair (19.6%) and laparoscopic hernioplasty (15.6%). Recurrence with suture repair was 10%, open mesh repair 3.3% and no recurrence was observed following laparoscopic repair.Conclusions: Prevention of IH is to be taken care of, by avoiding infection during index operation with thorough peritoneal toileting, proper surgical techniques and appropriate antibiotics. Although laparoscopic mesh repair needs more operating time and skill, it has lesser blood loss, hospital stay and recurrence rate when compared to other procedures.

Surgical site infection after penetrating abdominal trauma with bowel involvement: a comparison between HIV-seropositive and seronegative patients

The influence of HIV-infection on surgical site infection (SSI) after surgery for penetrating abdominal trauma is not investigated and therefore not as yet elucidated. This prospective study was performed with the aim to compare the SSI rate in human immunodeficiency virus (HIV)-seropositive and HIV-negative patients and to identify other risk factors for this abdominal wound complication. 98 patients who underwent small or large bowel resection and subsequent anastomosis due to penetrating abdominal trauma were included in the study. Injury related factors as well as demographical and physiological parameters, including HIV-status were analysed and superficial and deep SSI incidence rates were evaluated. Of the 98 patients, 23 patients (23%) were HIV-seropositive. The overall superficial SSI rate was 45% and the deep SSI rate was 15%. No significant difference in SSI (superficial or deep) in the HIV-seropositive and -negative group was demonstrated (superficial SSI HIV-pos vs HIV-neg: 61% vs 40%; p=0.172, deep SSI 22% vs 13%, p=0.276). Multivariate analysis identified five independent risk factors for SSI: postoperative CD4 count < 250 cells/μl, postoperative albumin < 30 g/L, relook operation, anastomotic leak and colonic anastomosis. HIV-infection is not an independent risk factor for developing SSI after penetrating abdominal trauma. Low postoperative CD4 count, irrespective of HIV status, low postoperative albumin, relook operation, anastomotic leak and colonic anastomosis are predictors for SSI irrespective of the HIV-serostatus. These factors should be considered in unison during the decision-making process of abdominal wound closure; planned secondary wound treatment or immediate application of negative pressure dressings in patients with a high-risk profile may decrease the hospital stay and the financial burden on the health care system.

Advanced Techniques in the Use of Negative Pressure Wound Therapy for Closure of Complex Neonatal Abdominal Wounds.

Negative pressure wound therapy (NPWT) has been described for closure of complex neonatal abdominal wounds, but advanced techniques for stoma or fistula control, skin protection, and the use of high pressure therapy not as well established. We identified neonatal patients at our institution who received NPWT for a complex abdominal wound, defined as a wound associated with a stoma or fistula with partial or complete dehiscence of the abdominal fascia or skin. We then reviewed techniques for decreasing wound contamination and protecting the newborn's skin. One patient had an especially complex wound; she was born at ∼23 weeks' gestational age (birth weight 580 g). She developed necrotizing enterocolitis and strictures, requiring multiple surgeries to relieve obstruction, ultimately resulting in an end ileostomy with mucous fistula. She suffered from wound dehiscence and retraction of her surgically created stoma, resulting in a complex abdominal wound with significant damage to the surrounding skin. We used advanced NPWT techniques to heal her wound, including topical skin protectants, placement of an adhesive dressing over the skin prior to placement of negative pressure dressing, placement of a negative pressure sponge directly on the wound bed and stoma, diversion of enteric contents away from the wound using a Malecot catheter, and an increase in the negative pressure applied. Complex neonatal abdominal wounds can be treated effectively using NPWT. The techniques we describe divert enteric contents away from the wound bed while maintaining negative pressure and protecting the surrounding skin. In addition, we used negative pressure up to -125 mm Hg and found it was well tolerated by our patients.

Early Closure of Infected Laparotomy Wound with Negative-Pressure Wound Therapy: Safety and Efficacy in 42 Consecutive Cases

Postoperative surgical site infections (SSIs) are one of the most common complications. SSIs after laparotomy have a high incidence and are complicated and expensive to heal. The aim of this study was to evaluate the safety and efficacy of a novel therapy of early closure of open abdominal SSIs wound combining wound irrigation with negative pressure wound therapy (NPWT). Open abdominal SSIs wounds were closed with sutures in 42 consecutive patients. Topical NPWT was applied over a closed wound with a deep drain to allow dynamic drainage and wound irrigation. CT scan with contrast medium injected through the deep drain was performed in patients with suspicious tracts detected during debridement surgery three days after surgery to identify a potential fistula. Wound healing and safety of the therapy was evaluated during an average six months follow-up. Closed wounds healed successfully in all the patients without recurrence of wound infection. Fistulas were easily diagnosed in all four fistula patients by using CT scan with contrast medium injection through the wound. Fistula was confirmed in these four patients at re-exploration. All the drain tube wounds healed spontaneously after drain removal. No severe adverse event occurred during therapy in any patients. With the aid of topical NPWT and deep drainage and irrigation, early closure of open SSIs wound can be done safely. We were also able to diagnose gastrointestinal fistulas at an early stage with the use of CT scan imaging after contrast injection into the wound.

Successful abdominal wound closure for treatment of severe peritonitis using negative pressure wound therapy with continuous mesh fascial traction: a case report

BackgroundSurgery for severe peritonitis often entails difficult wound closure and may require open abdominal management due to gut edema and/or concern of abdominal compartment syndrome. Negative pressure wound therapy (NPWT) is known to have good outcomes for wound closure after surgery for severe peritonitis. NPWT with continuous mesh fascial traction may result in even better outcomes, especially for fascial closure.Case presentationAn 81-year-old man was hospitalized for abdominal pain. At admission, computed tomography (CT) demonstrated multiple liver metastases and a tumor perforating the sigmoid colon. Acute peritonitis due to perforated sigmoid colon cancer was diagnosed, and emergency peritonitis surgery and Hartmann’s operation were performed. However, at the end of the operation, the surgical abdominal wound could not be closed due to gut edema and concern of abdominal compartment syndrome. Thus, the abdominal wound was left open and NPWT was performed in the primary operation. In the second and subsequent operations, NPWT with mesh fascial traction was performed. The wound was ultimately closed in the fifth operation, which took place 9 days after the primary operation.ConclusionsTreatment of severe peritonitis requires that gastroenterological surgeons learn some form of open abdominal management. This case suggests that NPWT with fascial mesh traction is a suitable solution. Furthermore, it does not require any special materials, and surgeons will find it easy to perform. In sum, NPWT with fascial mesh traction may be the preferred method of open abdominal management over other techniques currently available.

Comparison of non-absorbable (polypropylene) versus delayed absorbable (polydioxanone) suture material for abdominal wound closure after laparotomy

Background: Type of suture material used for fascial closure in laparotomies influences the incidence of post-operative complications. Currently there is no consensus on the superiority of either absorbable or non-absorbable suture materials for abdominal fascial closure. Aim of this study was to determine the superior suture material for abdominal wall closure after elective laparotomy among polypropylene and polydioxanone based on the occurrence of specific post-operative complications.Methods: A prospective observational study was conducted at Kasturba hospital, Manipal from September 2014 to August 2016. Patients admitted under General surgery, who underwent midline laparotomy were included in the study. Polydioxanone and Polypropylene suture materials were used for mass closure and post-operative complications were compared.Results: Hundred patients were included. The two study groups (Prolene and Polydioxanone) were homogenous, with no significant difference between age, BMI, co-morbidities and indication for surgery. Surgical site infection was significantly more in prolene group (p=0.031). Duration of surgeries was longer in prolene group (p=0.020), hence, a subgroup analysis was done and only surgeries under 4-hour duration were analysed. It showed no difference between the two groups with respect to surgical site infection (p=0.320). There was no significant difference between the two groups in burst abdomen and incisional hernia.Conclusions: There was no significant difference between Prolene and Polydioxanone when early and late post-operative complications were compared. Hence, either of the two suture materials can be used for abdominal wound closure in elective midline laparotomies.

A Novel Closure Technique for Complex Abdominal Wounds.

Abdominal wound closure is a challenge in patients undergoing colorectal surgery with a complex history of multiple abdominopelvic operations. Loss of domain of the abdominal fascia because of prior laparotomies precludes the use of simple, everyday abdominal wound closure techniques. Furthermore, ongoing intra-abdominal sepsis, with or without a concurrent entero- or colocutaneous fistula, increases the risk of postoperative morbidity and mortality in this patient population. We propose an abdominal wound closure technique for patients with multiple previous complex operations and subsequent ongoing abdominopelvic sepsis. Following completion of the intra-abdominal component of the operation, the abdominal wall fascial edges are identified and mobilized to allow for a smooth skin closure. The skin is brought together with a small amount of subcutaneous tissue in the abdominal wound line and sutured with a 1.0 Prolene stitch by using the vertical mattress technique. For both wound edges, a dental roll is inserted between the entry and exit points of the suture, with the suture material placed above and over the dental roll, and thus the dental roll is incorporated within the stitch when it is tied down. These stitches and dental rolls are placed along the length of the wound. No mesh is utilized, and the technique achieves skin closure with development of a subsequent ventral hernia. Good postoperative short-term and long-term overall outcomes were achieved in 14 patients who underwent complex abdominal wound closure. Two patients required further late operative intervention because of the incarceration of the known ventral hernia (at 34 and 120 months postoperatively). Complex abdominal wound closure in this setting is safe and feasible to achieve a healthy abdominal wall closure and enable healing by primary intention after colorectal surgery.

Optimized wound closure using a biomechanical abdominal model.

Suturing techniques for midline abdominal wall incisions vary between surgeons. This study uses a biomechanical abdominal model to assess tissue stretch using different suturing techniques for midline laparotomy closure. Deformation tests were performed on the linea alba of 48 porcine abdominal walls. Each pattern was tested three times at pressures ranging from 0 to 20 kPa using different continuous suturing techniques and a control. There was a sevenfold improvement when the best performing bite separation and bite width ([5, 16] mm) was compared with the most poorly performing combination ([15, 4] mm). The traditional bite and width separation ([10, 10] mm) and the recently proposed combination ([5, 5] mm) may not be optimal, and substantial improvements in surgical outcome may be achieved by changing to a [5,16]-mm combination. These findings suggest using a small bite separation (5 mm) and large bite width (16 mm) during abdominal wound closure may be optimal. Surgical relevance Suturing techniques for midline abdominal wall incisions vary between surgeons. This experimental study suggests substantial potential for improved tissue apposition by changing the suturing approach from the traditional clinical recommendation of 10 mm for both bite separation and bite width to a bite separation of 5 mm and a bite width of 16 mm. These findings support recent European Hernia Society guidelines and the recent randomized STITCH (Suture Techniques to Reduce the Incidence of The inCisional Hernia) trial, which found that small separations are more effective than large separations, but suggest that they should be combined with large bite depths.

Mass closure versus layered closure of midline laparotomy incisions: a prospective comparative study

Background: The ideal method of abdominal wound closure remains to be discovered. It should be technically so simple that the results are as good in the hands of a trainee as in those of the master surgeon. The best abdominal closure technique should be fast, easy, and cost effective while preventing both early and late complications. Present study is undertaken to compare the two methods (Mass closure and Layered closure) of laparotomy wound closure in relation to post-operative complications, time for wound closure and cost effectiveness in both groups and also to decide the most effective method among the two.Methods: This prospective comparative study was conducted in department of surgery at a tertiary care teaching hospital at Solapur (Maharashtra) from January 2006 to January 2009. On admission, patients suspected of having intraabdominal pathology, a thorough clinical e and general assessment was done. Necessary radiological and biochemical investigations were done to support the diagnosis. After confirmation of diagnosis patients were subjected for exploratory laparotomy. The laparotomy wound was closed with either by Mass closure or Layered closure technique. Patients were followed up for 6 months in post-operative period for detection late complications.Results: Total 60 patients of were studied. Majority of patients were in 61 to 65 age group. Male outnumbered the females. Incidence of early complications like seroma, wound infection is more in layered closure group as compared to mass closure. Mean wound closure time is more in layered closure group. Mass closure technique is more cost effective than layered closure group.Conclusions: Mass closure technique is less time consuming, more cost effective and safe for closure of midline laparotomy incisions.

An Observational Study of Midline Abdominal Wound Closure Using Small Tissue Bites versus Large Tissue Bites with Reference to Surgical Site Infections and Wound Dehiscence

Background: Midline incisions have advantage of rapid and wide access to the abdominal cavity with minimal damage to muscles, nerves and the vascular supply of the abdominal wall, hence causing minimal long term morbidity. The techniques of wound closure after midline laparotomy differ among operating surgeons and institutions. Faulty techniques and suture materials used play a crucial role in post-operative wound complications like stich abscess, surgical site infections, wound burst and incisional hernia. Aims: The aim of this study is to assess the outcome of midline abdominal wound closure using small tissue bites versus large tissue bites with reference to surgical site infection and wound dehiscence. Materials and methods: The study is the prospective observational study conducted in the department of general surgery Government Medical College Srinagar. A total of 100 cases were enrolled and studied who underwent midline laparotomy in the elective as well as emergency settings from 2015 to 2018. In 50 patients midline incisions were closed with large tissue bites placed at least 10 mm from the wound edge and 10 mm apart and in another 50 patients small tissue bites were used placed 5 - 7 mm from the wound edge and 5 - 7 mm apart and included only the aponeurosis in the stitches without peritoneum. Results: In all, 100 patients, 50 patients were subjected to large tissue bites and another 50 patients to small tissue bites. 15 patients out of 50 patients (30%) in large tissue bites group and 10 patients (20%) in small tissue bites developed surgical site infection. 8 patients out of 50 patients (16%) in large tissue bites group and 4 patients (8%) in small tissue bites developed wound dehiscence. Conclusion: A total of 100 patients who underwent abdominal surgery through midline incision were divided into two groups. In 50 patients midline wound was closed using large tissue bites and in other 50 patients; small tissue bites was used to close midline incision including only aponeurosis. The research findings show that the small stitch length between 5 to 7 mm depending on the wound site is the ideal stitch length to close a midline incision. However, there was no statistical deference seen in both groups with reference to surgical site infection and wound dehiscence.

Hughes Abdominal Repair Trial (HART)—abdominal wall closure techniques to reduce the incidence of incisional hernias: feasibility trial for a multicentre, pragmatic, randomised controlled trial

ObjectivesIncisional hernias are common complications of midline abdominal closure. The ‘Hughes Repair’ combines a standard mass closure with a series of horizontal and two vertical mattress sutures within a single...