Laparotomy Wound Research Articles

A Comparison between Skin Stapler and Polypropylene Sutures in Closing Laparotomy Wounds: A Study of 100 Cases

Objective: Healing of laparotomy wounds is associated with number of factors. The aim of the study was to compare skin stapler and polypropylene sutures in closing laparotomy wounds. Materials and method: This randomized controlled trial study was conducted at the Department of Surgery, Sir Salimullah Medical College Mitford Hospital, Dhaka, Bangladesh. The study duration was 6 months, from July 2010 to December 2010. A total of 100 participants were included in the study, divide in two equal groups of 50 participants. The first group received interrupted suture with 2/0 polypropylene. The other group received skin staples. Results: The mean time for closure with suture and staple were 3.7±SD and 22.5±SD cm/min respectively (p- value<0.05). Rate of wound closure was calculated in cm per minute and materials were compared statistically in pairs by t- test. Wounds were closed five times faster with staples then suture (p<0.001). In relation to post-operative infection, 17 (34%) cases developed wound infection in sutured group and 15 (30%) patients in stapled group. Most of the infection occurred in the emergency contaminated cases. There was no significant association between wound infections and method of skin closure (p> 0.05, chi square= 3.15). Conclusions: Staples were well-liked by operators and resulted in substantial and worthwhile savings in time for wound closure.

WE5.7 A Comparison of Small and Large Bites Closure of Fascia in Midline Laparotomy Wounds: Experience in a District General Hospital

Abstract Aims Small bites (SBC) laparotomy closure (5mm fascial bites, 5mm apart) is thought to decrease incisional hernia rates compared to large bites (LBC) closure (1cm bites, 1cm apart). A colorectal surgeon in our centre changed practice following the STITCH trial. We aimed to assess whether this change affected outcomes. Methods All midline laparotomy patients immediately before and after the change in practice in 2017 were considered for inclusion. Data on demographics, co-morbidities, operation details, length of stay (LoS), complications and outcome were gathered from operation notes and electronic patient records. Follow up was censored at 12 months to make groups comparable. Results 80 patients were included (38 SBC; 42 LBC), undergoing laparotomy from August 2014-December 2020. Age, gender and ASA grade were comparable between groups. 58% SBC; 71% LBC were emergency cases. LoS was 7 days (range 3–166) for SBC; 11 (5–369) LBC. Overall wound complication rates were similar (23.7% SBC; 19% LBC, p=0.61). There were 4 (10.5%) burst abdomens following SBC and 2 (4.8%) following LBC (p=0.21). 1 (2.6%) SBC and 3 (7.1%) LBC developed incisional hernia at 12 months. Conclusions SBC did not result in decreased wound complications: although incisional hernia rate and LoS were reduced, there was a (non-significant) higher rate of burst abdomens in SBC. The latter may reflect a learning curve effect of a new technique. This study suggests SBC is feasible in a DGH, but long-term outcomes of SBC are yet to become apparent, which may have affected results in this cohort.

Treatment tactics for a patient with acquired hemophilia: continuous infusion of recombinant activated coagulation factor VII and the inhibitor eradication

Introduction. Acquired hemophilia is a rare autoimmune disease caused by an inhibitor to clotting factor VIII (FVIII). It complicates the course of many diseases, in particular autoimmune diseases, and in women is often associated with pregnancy.Aim — to present a case of successful treatment of a patient with acquired hemophilia using long-term continuous infusion of rFVIIa and inhibitor eradication as a result of immunosuppressive therapy.Main findings. A clinical observation of severe hemorrhagic syndrome in a patient with acquired hemophilia associated with pregnancy is presented. Uterine bleeding in the patient after spontaneous delivery, refractory to standard hemorrhagic syndrome treatment, required multiple surgical interventions. Laboratory tests showed prolongation of APTT, CT in the INTEM rotational thromboelastometry test, a decrease in plasma FVIII activity and presence of inhibitor to FVIII. Vacuum-assisted closure was applied to treat infected laparotomy wound. Therapy for acquired hemophilia consisted of hemostatic therapy and the inhibitor eradication. Hemostatic therapy included a continuous infusion of rFVIIa at a rate of 30 μg/kg/h with a gradual decrease up to 9.6 μg/kg/h, as well as its fractional administration before every surgery at a dosage of 80 μg/kg. The effectiveness of the therapy was assessed by the dynamics of CT in the INTEM test and the shortening of the APTT. The inhibitor eradication was achieved by prednisolone therapy, combined immunosuppression with rituximab and azathioprine, followed by its replacement with cyclophosphamide. As a result, the hemorrhage was stopped, reference plasma activity of FVIII and eradication of the inhibitor were reached.

The choice of suture material and techniques of the laparotomic wound suture

Surgical technique and suture material applied in laparotomic wound suturing are important factors determining the risk of incisional hernias and other wound complications. Optimization of laparotomic wound closure will undoubtedly reduce the frequency of postoperative complications, including incisional hernias and subsequent secondary surgeries in patients. Thus it will improve their quality of life and, in economic terms, significantly reducing the cost of health care resources. Despite the great work carried out in this area by many groups of medical specialists and scientists around the world, today there is no single, generally accepted and proven advantage of the technique for closing a laparotomic wound.

A CLINICAL STUDY OF ABDOMINAL WOUND DEHISCENCE

INTRODUCTION:-AWD (abdominal wound dehiscence) is a word that is widely used to describe the separation of different layers of an abdominal wound before it has healed completely. Acute laparotomy wound failure and burst abdomen are two more words that are used interchangeably. Wound dehiscence happens when a wound does not develop the necessary strength to withstand the demands exerted on it. Dehiscence happens when sutures are disrupted by external pressures, absorbable sutures dissolve too quickly, or tight sutures rip through tissues due to excessive strain. AWD has been a long-standing problem for which no surgical unit has offered a complete solution (i.e. none of the surgical units worldwide has reported 0 percent failure rate). However, numerous institutes around the world have been successful in achieving and maintaining failure rates considerably below 1%. These gures, on the other hand, do not deter researchers from continuing their efforts to solve the problem. In the last ten years, there have been a slew of publications attempting to explain how to solve this problem. The goal of this study is to assess the prevalence of abdominal wound dehiscence in relation to various risk factors, co-morbidities, and treatment options. The study aimed at nding out theAIM:- prevalence of abdominal wound dehiscence with respect to demographic factors, nature of preceding surgery and different risk factors and also to study the effective management of abdominal wound dehiscence. An Observational studyMETHODS:- on 60 patients comprising all patients admitted to Silchar medical College and Hospital a tertiary care center in Assam within the study period of 1st January 2021 to 31st July 2021 with diagnosed abdominal wound Dehiscence after undergoing surgical interventions. :-The majority of the patients in this study were between the ages of 41 and 50. Majority were male.RESULTS 81.67% were operated as emergency surgery. 66.67% have undergone procedures which are classied as contaminated. (80%) were operated with mid line incision. 58% patients with peritonitis due to hollow viscus perforation. 58.33% had hypoalbuminemia. Malnutrition, DM, HT, pulmonary diseases, anemia etc. are important risk factors for wound dehiscence. CONCLUSION:-Because of the poor blood supply at Linea Alba, individuals who had a midline laparotomy had a higher risk of wound dehiscence than those who had a paramedian laparotomy. Wound dehiscence is more likely in people with a BMI greater than 25, compared to those with a BMI less than 25. In this study wound dehiscence is mainly associated with complications like hypoproteinemia and pulmonary complications and anaemia.

Comparative study between continuous and interrupted suturing for rectus sheath closure in exploratory laparotomy

Background: Exploratory laparotomy is a major surgical procedure. Midline laparotomy is the most common technique of opening the abdomen as it is simple, provides adequate exposure to all four quadrants, and affords quick exposure with minimal blood loss. Laparotomy wounds have been closed in various ways in terms of continuous versus interrupted closure, single layer versus mass closure, and absorbable versus non-absorbable sutures. Aims and Objectives: The aim of the study was to find out the technique of rectus sheath closure in patients undergoing exploratory laparotomy that can reduce the burden of complications in post-operative period. Materials and Methods: It is a hospital-based prospective randomized observational study which was conducted in a rural-based tertiary care hospital and medical college with a time frame of about 1½ years. A total number of 74 patients of adult age group (21–70 yrs) admitted in general surgery ward of Bankura Sammilani Medical College and Hospital, undergoing exploratory laparotomy. Results: Thirty-seven (50%) patients of midline laparotomy were closed in continuous technique. Rest 37 (50%) patients were closed in interrupted technique. The hospital stay was similar in both groups. There was no significant difference in incidence of wound infection (P=0.4687). Wound dehiscence and requirement of burst abdomen repair was significantly higher in continuous suture group as compared to interrupted suture group, but mean closure time (P<0.0001) and mean suture length (P=0.0436) were significantly higher in interrupted suture group. Conclusion: The major complication of emergency laparotomy is wound dehiscence which leads to increased morbidity and subsequent requirement of re-operation of burst abdomen and hospital cost. In our study, we found that interrupted suturing method of abdominal closure is better in respect to major post-operative complications though it requires more suture length and time.

Features of the tissue repair process in urgent surgical abdominal pathology in combination with COVID-19

The OBJECTIVE was to study the process of wound healing after surgical interventions in patients with urgent surgical diseases in combination with a new coronavirus infection.METHODS AND MATERIALS. We observed for 80 patients with urgent abdominal diseases. Group I – 48 patients with various urgent diseases of the abdominal organs, group II – 32 patients with similar diseases occurring against the background of coronavirus infection. Stages of postoperative examination: 2, 4 and 7 days after surgery. The nature and rate of wound regeneration was assessed by cytological examination of wound exudate. In the tissues along the suture line, trophic indicators and microcirculation were recorded.RESULTS. The number of neutrophilic leukocytes in the wound exudate in group II exceeded the values of group I by 38.7–116.8 % with a slowed down dynamics of recovery. In the II group of patients, the number of tissue polyblasts was reduced at all stages of observation in comparison with the control group by 34.2–41.9 %. The number of lymphoid polyblasts in the main group was increased in comparison with the control group on days 2, 4, 7 of observation by 33.1 %, 63.2 %, 354.9 %, respectively. The indices of microcirculation in the tissues of the laparotomic wound in the group II of patients changed to a greater extent. The redox potential and oxygen diffusion coefficient in the group II were lower than the control figures by 9.8 – 37.2 % and 35.3 – 38.1 %, respectively. The number of complications according to the Clavien – Dindo classification in the group II of patients compared to the group I was more than 6 times higher.CONCLUSION. In patients with urgent diseases of the abdominal organs with concomitant coronavirus infection, the process of incomplete reparative tissue regeneration of the wound area slows down, which increases the risk of complications. The main factors that reduce the rate of tissue healing are disorders of microcirculation and bioenergetics.

Study of Different Methods of Midline Laparotomy Incision Closure and their Outcomes

Background: The closure of such a laparotomy wound is important to minimize the postoperative complications like wound pain, infection, dehiscence and incisional hernia. Aims: The objectives of this study was to study the various techniques of midline laparotomy incision closure and their outcomes like wound dehiscence, wound infection and incisional hernia up to six months. Materials and Methods: A total of 100 patients who were operated for midline laparotomy were included as subject material after they satisfied the inclusion and exclusion criteria. Results: Most common indication of laparotomy in the study was gastric ulcer perforation. Incidence rate of surgical site infection, wound dehiscence and incisional hernia was lower in cases of smaller bite length. Incidence rate of surgical site infection wound dehiscence and incisional hernia was lower with continuous suturing. Conclusion: The study results showed that best technique for midline laparotomy incision closure is small bite continuous suturing with mass closure. The small bites technique with continuous suturing showed better results than small bite technique with interrupted suturing. Present study thus recommends that small bite continuous suturing with mass closure should be considered as the standard closure technique for midline incisions.

Incisional Negative Pressure Wound Therapy to Decrease the Incidence of Surgical Site Infections in Trauma Laparotomy Wounds.

Surgical site infection (SSI) is a common post-operative complication, especially in trauma laparotomies. Incisional negative pressure wound therapy (iNPWT) is a novel technique in reducing SSIs. We aim to study the rate of wound complications in trauma laparotomy with standard primary closure with staples vs iNPWT. We had 152 patients meeting inclusion criteria who underwent emergent trauma laparotomies performed at Sentara Norfolk General from 2017 to 2020. We had 79 patients in the standard staple group and 73 patients in the iNWPT group. We then analyzed surgical site infection rates and wound complication rates in both groups within a 30-day period. The wound infection rate in the staple vs staple plus iNPWT was 10.0% vs 3.8%, respectively (P = .13). Wound dehiscence rates were 24.1% vs 10.13%, respectively (P = .02). When looking at a subset of patients with hollow viscous injury, the rate of SSIs was statistically lower in the iNPWT group. Prior to the introduction of the incisional vacuum-assisted closure (VAC) to our practice compared to after its introduction, 39.25% of wounds were left open vs 19.51%, respectively (P = .001). Our data identified a trend toward a decrease in overall SSIs in trauma laparotomies closed with iNPWT. The use of iNPWT demonstrated a decrease in superficial wound dehiscence and a decrease in SSIs in patients with associated full thickness bowel injury. With iNPWT, we are more aggressive with primarily closing trauma laparotomy wounds. This shows promise for increasing primary closure rates while simultaneously decreasing overall superficial surgical site infection rate.

Difference between delayed anastomosis and early anastomosis in damage control laparotomy affecting the infusion volume and NPWT output volume: is infusion restriction necessary in delayed anastomosis? A single-center retrospective analysis

ObjectivesDuring temporary abdominal closure (TAC) with damage control laparotomy (DCL), infusion volume and negative-pressure wound therapy (NPWT) output volume are associated with the success and prognosis of primary fascial closure....

Robot-assisted laparoscopy for deep infiltrating endometriosis: a retrospective French multicentric study (2008-2019) using the Society of European Robotic Gynecological Surgery endometriosis database.

This study aimed at assessing perioperative results of robot-assisted laparoscopy (RAL) in the context of deep infiltrating endometriosis (DIE). This retrospective French multicentric study included all patients with DIE who underwent surgical treatment managed by RAL (Da Vinci® System). From November 2008 to June 2019, patients were included in a single European database, in Robotic Assisted Laparoscopic Gynecologic Surgery, with Society of European Robotic Gynecological Surgery collaboration. Patients had different DIE sites as follows: gynecological, urological, or digestive, or combinations of these. Surgical procedures and perioperative complications were evaluated. To assess complications, patients were divided into the following four groups according to surgical procedure and DIE site: gynecological only; gynecological and urological; gynecological and digestive; and gynecological, urological, and digestive. A total of 460 patients treated at one of eight health-care facilities from November 2008 to June 2019 were included. Median operative time was 245min (IQR 186-320), surgeon console time was 138 ± 75min and estimated blood loss was 70.0mL ± 107mL. Among this patient sample, 42.1% had a multidisciplinary surgical approach with a digestive or urology surgeon in addition to gynecology surgeon (25.5% and 16.6% of cases, respectively). Among those with intraoperative complications (n = 25, 5.4%) were primarily conversion to laparotomy (n = 6, 2.0%), transfusion (n = 2, 0.6%), and organ wounds (n = 8, 1.7%). Overall, 5.6% had severe postoperative complications (Clavien-Dindo classification ≥ Grade 3). This is among the largest published series addressing RAL for DIE. Interest in this procedure appears promising, with no observed increases in blood loss or in peri- or post-operative complications. DIE laparoscopic surgery can require complex surgical procedures performed by multidisciplinary surgical teams. Thus, it may be one of the best candidates for RAL within gynecology surgery.

РОЛЬ МЕСТНОЙ АНЕСТЕЗИИ ЛАПАРОТОМНОЙ РАНЫ В ПРОФИЛАКТИКЕ ПОСЛЕОПЕРАЦИОННЫХ ОСЛОЖНЕНИЙ

Introduction. Wound pain and postoperative complications are a leading problem for patients operated on abdominal organs. In most cases, these two issues are interrelated; that is why their management requires a comprehensive modern approach. Aim. The aim of the study is to evaluate the literature data to identify a causal relationship between wound pain and some complications after abdominal surgeries and to determine the advantages of local anaesthesia of a laparotomic wound, taking into account its additional favourable features. Material and methods. Based on the analysis of Russian and foreign articles, the review presents the structure of the main wound, intra- and extra-abdominal complications after laparotomy, and their producing factors. Moreover, the role of pain during the postoperative period with its multiorgan effect is clearly demonstrated. We considered characteristics of local anaesthetics with their non- standard effects, as well as a comparison of publications regarding the advantages of local anaesthesia in the wound with the systemic administration of parenteral (narcotic and non-narcotic) analgesics, where side effects were also analyzed. Results and discussion. Wound, intra- and extra-abdominal complications after laparotomy are very common today. Pain in the wound area is important in developing each of the complications: it provokes hypodynamia in the postoperative period, develops intestinal paresis, reduces the chest excursion and, as a result, worsens the life quality. All this provokes an increase in intra-abdominal pressure, impaired blood circulation of abdominal organs, wound ischemia in the suture area, lung congestion, which worsens hemodynamics and leads to the systemic consequences. Local anaesthetics are devoid of the well-known side effects of narcotic analgesics and non-steroidal anti-inflammatory drugs. However, they have additional positive local effects. Conclusion. Scientific data analysis has shown that continuous infusion of local anaesthetics into the preperitoneal space of a median laparotomic wound is a promising method for relieving wound pain and preventing postoperative intra- and extra-abdominal complications.

A CLINICAL STUDY OF THE FACTORS AFFECTING POST LAPAROTOMY WOUND HEALING

BACKGROUND: Wound Healing is the summation of a number of processes that follow injury. Despite immense advances in the technique of wound creation and closure, there continues to be an important percentage of patients undergoing abdominal operations, suffering from delayed wound healing and partial wound failure. Apart from increasing patient morbidity and hospital stay, it also is a psychological blow to both the surgeon and patient alike. The incidence of post-operative wound dehiscence was investigated in patients in several studies (e.g., 1.25 per 1,000 discharges at 0 to 17 years, 1.74 at 18 to 44 years, 2.65 at 45 to 65 years, and 3.77 at 65 or more years. Additionally, it was found that this complication resulted in an increased mean length of stay (by 21.1 days) and a tremendous increase in charges for affected patients, with 5.7 times higher odds of in-hospital mortality.Wound Infection rate varies from 6.8 percent to 21.4 percent depending on the procedure and other patient factors. The aim of this study is to assess the various factors inuencing post laparotomy wound healing. To identify the pre-operative, operative and post operative risk factors in patients having poor wound healing. RESULTS This prospective study was conducted in Government General Hospital, kurnool. A total of 100 patients undergoing laparotomies were studied .40 patients were found to have delayed wound healing. The strongest association for delayed healing was found to be wound infection, followed by chronic cough,steroids and poorly controlled diabetes. CONCLUSIONS The incidence of delayed healing was found to be higher in our study with increased incidence of wound infection. It was found that emergency laparotomies were associated with an increased incidence of wound infection and thereby delayed healing. Poor wound healing is also associated strongly with poor nutrition and uncontrolled diabetes. These factors should be taken into account and efforts have to be made to correct the risk factors pre or post-operatively.

Secondary suture for postoperative suppuration of the abdominal wall. Spinger (Zbl. F. Gyn., 1933, no. 31)

Sringer (Zbl. F. Gyn., 1933, No. 31) recommends using Villaag's secondary suture for suppuration in the area of ​​a laparotomic wound. His technique is as follows: under light ether anesthesia, a wound opens throughout the entire area of ​​suppuration; the wound surface is thoroughly cleaned with hydrogen peroxide, and firmly adhering deposits are removed with the help of a tupfer; then the wound is connected in layers with knotty sutures (on the skin a knotted silk suture, not staples); stopping bleeding is done by injecting; the dressing consists of dry absorbent gauze; sutures are removed in 6-7 days.

A comparative study of mass closure versus layered closure in midline laparotomy incisions

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 procedures. Methods: This prospective comparative study was conducted in department of surgery at Narayana medical college and hospital Nellore from December 2019 to December 2021. On admission, patients suspected of having intraabdominal pathology, a thorough clinical 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 of late complications. Results: Total 30 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.

Closure of Abdominal Incisions Following Laparotomy for Peritonitis in Children: Primary Closure or Delayed Primary Closure?

Background: There is need to determine the optimal management strategy for dirty abdominal surgical wounds. The aim of this study was to evaluate the post-operative wound complications in children whose dirty surgical wounds were closed primarily, in relation to those closed by delayed primary closure. Materials and Methods: This was a prospective evaluation of children, aged 15 years and younger, who had laparotomy for peritonitis in a teaching hospital in Enugu, Nigeria. This study covered a 5-year period. The following data were evaluated: patients’ age, gender, presenting symptoms, laboratory results at presentation, duration of symptoms before presentation, time interval between presentation and intervention, intra-operative finding, definitive operative procedure performed, complications of treatment, and outcome of treatment of the 2 groups of patients. Results: A total of 204 cases of peritonitis in children were operated upon during the study period. The incisions were closed by primary closure (Group A) in 104 (51%) while 100 (49%) surgical wounds were closed by delayed primary closure (Group B). More males were involved. All the patients had abdominal pain and about half the patients were anemic and had electrolyte imbalance at presentation. Typhoid intestinal perforation was the most common cause of peritonitis and closure of ileal perforation was the most frequent performed surgical procedure. Comparing the 2 groups of patients, surgical site infection and stitch related were less common in group B patients whose surgical incisions were closed by delayed primary closure. Conclusion: Delayed primary closure of dirty laparotomy incisions has less complication in terms of surgical site infection and stitch related complications. Therefore, delayed primary closure of dirty laparotomy wounds is advocated in pediatric population.

The effect of suction wound drain on laparotomy wound healing in emergency colorectal surgeries

The effect of suction wound drain on laparotomy wound healing in emergency colorectal surgeries

MANAGEMENT AND OUTCOME OF ABDOMINAL WALL CLOSURE IN EMERGENCY LAPAROTOMY AT A TERTIARY CARE CENTRE

Objective: Abdominal wall closure of an emergency laparotomy involves a great deal of consideration. An ideal laparotomy wound closure should be efficient. provide strength and serve as a barrier to infection. The aim of this study is to compare and evaluate the advantages of layered closure in comparison with the mass layered closure, the types of suture materials used in the closure, absorbable/nonabsorbable and its correlation with post operative complications such as wound sepsis, burst abdomen and incisional hernia. Methods: This prospective study was carried out over a period of 18 months enrolling a total of 90 patients split into two groups with group 1 undergoing mass closure using both interrupted and continuous methods and group 2 undergoing layered closure using both interrupted and continuous methods of suturing. Results: A higher rate of wound complications was noted in the layered closure group (37.7%) than the mass closure group (17%). Wound complications were also noted to be higher in closures done with prolene suture (37.7%) than PDS (20%). As far as techniques were concerned, interrupted and continuous suturing had a similar rate of complications. Of all the comorbidities, considered in the study, the highest rate of wound related complications were seen in patients with pulmonary complications (13.3%). Conclusion: Although the ideal way to close an abdomen post laparotomy has not yet been discovered, our study shows that mass closure with PDS suture to close the abdominal wall should be advocated as there is decreased early and late post operative wound complications Keywords: PDS.

ISIT POSSIBLETO PREDICT POSTOPERATIVE ABDOMINAL COMPLICATIONS BYLASER DOPPLER FLOWMETRY?

In this study, the authors chose to assess the prognostic capabilities of the laser Doppler flowmetry method for postoperative complications in patients with advanced peritonitis. A retrospective randomized controlled trial (evidence level IIB) was performed. The study involved 54 patients who were operated on for secondary widespread fibrinous-purulent peritonitis. The patients were divided into two groups with 27 patients in each: the main group — with developed postoperative complications and a comparison group — without complications. The research was carried out by the analyzer "Lazma MC-1" (Russia). Scanning of the parietal and visceral peritoneum, small and large intestines, as well as the edges of the laparotomic wound was performed. A total of 504 scans were performed. The relationship of indicators was determined using the Spearman's rank correlation coefficient. Microcirculation indices in both groups were characterized by pronounced disorders of pre- and postcapillary resistance and disorders of tissue perfusion. The following indicators turned out to be statistically significant: percentage of microcirculation (r= 0.77 at p≤0.05), standard deviation (r = 0.67 at p≤0.05), coefficient of variation (r = 0.59 at p≤0, 05) and shunting percentage. In patients of the main group, the changes were expressed in an increase in pre- and postcapillary resistance, progressive arterio-venular shunting. All this ultimately led to disturbances in the perfusion of the intestinal wall, peritoneum and laparotomic wound, which led to postoperative complications. The technique of abdominal laser Doppler flowmetry can be a prognostic method that allows predicting the development of early postoperative complications after primary surgery and making appropriate adjustments to the treatment.

Usefulness of a needleless suture technique for midline laparotomy wound dehiscence: a case report

Surgical wound dehiscence after a laparotomy is a serious complication, and it presents the mechanical wound healing failure of surgical incisions. Since the development of needleless suture techniques, there have been attempts to use a needleless suture for wounds from several surgery types. Recently, many studies have shown that a needleless suture technique leads to good wound healing results. It is rapid, cost effective, can minimize ventilator dependency, and is well tolerated by patients. Here, we report a case of a patient who received a needleless suture technique for midline laparotomy wound dehiscence.