Midline Wound Research Articles

Effectiveness of Continuous versus Interrupted Closure of Midline Wound in Emergency Laparotomies in Terms of Wound Dehiscence

Background: Midline laparotomy is widely recognized as the preferred technique for abdominal surgeries due to its simplicity and the effective exposure it provides. Despite its prevalence, the optimal method for closing the incision remains a topic of debate among surgeons, particularly when balancing the risk of wound dehiscence with the practicalities of surgical practice. The mechanical properties of suture materials and techniques, such as continuous versus interrupted suturing, directly influence wound integrity during the critical postoperative period. Objective: The aim of this study was to compare the effectiveness and complication rates of continuous versus interrupted suturing techniques in midline laparotomies, with a focus on the incidence of wound dehiscence. Methods: This randomized controlled trial included 180 patients undergoing emergency laparotomy, divided into two groups: continuous closure (Group A) and interrupted closure (Group B). The study was conducted at Lady Reading Hospital MTI, Peshawar, with ethical committee approval. Participants were informed, consented, and demographic data were recorded. Suture techniques were performed by an experienced surgeon, and patients were monitored for wound dehiscence up to the 15th postoperative day. Data were analyzed using SPSS version 25. Results: Group A reported a wound dehiscence rate of 14.4%, with an effectiveness rate of 85.6%. In comparison, Group B showed a significantly lower dehiscence rate of 5.6% and an effectiveness rate of 94.4%. The age-wise distribution of effectiveness indicated no statistically significant difference between the groups across various age ranges, with P-values ranging from 0.2766 to 0.6037. Gender-wise, males and females also did not show significant differences in effectiveness between the two groups. Conclusion: Interrupted suturing for midline laparotomy closures showed a lower incidence of wound dehiscence compared to continuous suturing. However, factors such as increased surgery time and cost, along with postoperative issues like stitch sinus formation, need consideration. Further large-scale studies are recommended to evaluate the long-term outcomes and provide a more comprehensive assessment of the two techniques.

Parastomal hernia after radical cystectomy. Incidence, natural history and predictive factors - A single center study.

Parastomal hernia (PH) is one of the most frequent complications after stoma creation. Our objective was to analyze the incidence, evolution and predictive factors of PH in Bricker-type urinary diversion. Case series analysis of 125 patients submitted to radical cystectomy and ileal conduit diversion for cancer in a single center during 2006-2021. Patient's record and imaging tests were reviewed to identify those suffering PH. Moreno-Matías classification was used to define radiological PH (rPH). Demographic and preoperative characteristics of the patients, surgical details and postoperative complications were recorded. Univariate and multivariate analyses were conducted to determine the effect of each predictive variable on the development and progression of PH. 21.6% of patients developed PH (median follow-up 37 months). Incidence increased with follow-up time (15.2% at 1 year, 20.8% at 2 years). BMI ≥ 25 (Expβ 8.31, 95% CI 1.06- 65.18, p = 0.04), previous midline laparotomy (Expβ 6.74, 95% CI 1.14-39.66, p = 0.04) and wound infection (Expβ 3.87, 95% CI 1.21-12.33, p = 0.02) were significantly associated with PH. Half of the patients with hernia had symptoms, 25.9% requiring surgical correction. 46% of type 1 hernias and 40% of type 2 hernias progressed to grade 3 with a median of 11 months. No variable was associated with radiological progression. This study proved 3 independent factors (overweight, laparotomy and wound infection) that increase the risk of developing PH.

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.

634 Dehisced Functioning Stoma Healed with Novel use of Negative Pressure Wound Therapy

Abstract Background Three years following bowel resection and colostomy formation for colorectal cancer a 62 year old man developed a parastomal hernia. On Day11 following laparoscopic repair and stoma formation the midline and stoma wounds dehisced. The stoma had a superficial wound extending 1cm but the lateral edge of this wound had a cavity 4x5x10cm. This wound presented challenges regarding the adherence of both dressings and the stoma bag. Aim During an exploration under anaesthesia, no purulent fluid or mesh was located in the cavity. Initially dressed with betadine wick and a JVAC drain, however, the moisture led to repeated stoma bag detachment and leakage of faeces into the wound. Method Consequently, to speed up healing and contain the faeces, negative pressure wound therapy (NPWT) was used around the stoma. The peristomal area was dressed with hydrofibre and hydrocolloid to provide a base, the cavity with polyvinyl alcohol foam, the stoma protected with Fistula Funnel (3M, San Antonio, Texas) and polyurethane granufoam applied around the wound with a pressure of -150mmHg. Following application of the NPWT a hole was cut to allow stoma contents to be evacuated and a stoma bag applied. Result Within three weeks the cavity was 3x4x1cm and NPWT discontinued. Conclusion The use of NPWT is contraindicated over exposed organs and the need for an occlusive dressing presents active outflow of contents. However the use of a soft, flexible silicone funnel allowed a complex wound to be healed in weeks, when conventional treatment wound have taken months.

OC-039 PROPHYLACTIC NEGATIVE PRESSURE WOUND THERAPY FOR COMPLEX VENTRAL HERNIA REPAIR, A CASE SERIES

Abstract Aims Presenting our 1-month results in 20 patients with prophylactic negative pressure (pNPWT) applied in complex ventral hernia repairs. Material & Methods pNPWT was applied when high surgical site occurrences (SSO) risk factors and when colorectal procedures, huge panniculectomies, active cutaneous/mesh infections or loss of domain are associated. Our results are compared with SSO incidence calculated with HW-RAT score. Results 10 men and 10 women with 67.55 (43–84) year-old. BMI 32.01 kg/m2 (24–55). 55% ASA III, 35% II, 10% I. Most relevant risk factors: 3 stoma closures, 3 loss of domain, 2 paraestomal, 2 peritonitis, 2 W3, 2 multi-recurrences, 1 infected mesh, 1 synchronic colonic fistula. HW-RAT SSO score (1-less risk- to 5 -maximum-): 3 II, 3 III, 12 IV and 2 V. pNPWT was applied to 17 midline wounds, 1 bilateral subcostal, 1 colostomy site and 1 midline+colostomy for 6–10 days (mode 7). 12 patients (60%) had 19 complications, 3 grade IIIB and one IVa. Only 1 patient (5%) had surgical site infection (SSI): 1 infected seroma presenting at 16th postoperative day requiring readmission, drainage, and negative pressure (grade IIIA). Global HW-RAT estimated SSI incidence: 15.76%. Two patients had other causes postoperative peritonitis, none of which affected the wound. At 1 month another 2 seromas (1 grade I, 1 grade III) and one 3cm haematoma appeared. Conclusions pNPWT in high-risk patients is safe and can significantly reduce SSI and SSO (in our series from 15% to 5%). Estimated NNT for preventing 1 SSI in the literature is 9 patients.

Review of incisional hernias

The 10 to 15% of patients get incisional hernias following any type of abdominal wall incision, with midline wounds carrying a larger risk (3 to 20%). Infection at the surgery site, obesity, smoking, malnutrition, and poor surgical technique are risk factors. Clinical signs include an abdominal bulge at or near a prior incision, which, in non-obese individuals, is frequently identified by palpating the split borders of the fascial defect. CT imaging is particularly useful for complicated ventral hernias, which are characterized by enormous size or considerable loss of dominance. For the purpose of detecting any contents within the hernia sac and deciding whether preoperative abdominal expansion is necessary to lower the risk of postoperative abdominal compartment syndrome, preoperative CT imaging is crucial. When clinically necessary, surgeons should think about making an incision outside the midline and employ the proper fascia closure procedures to lower the likelihood of an incisional hernia. Although the implantation of preventative mesh during the closure of abdominal incisions is being studied, routine usage is not advised owing to probable long-term problems. Incisional hernias can be treated surgically or expectantly, and the patient should be informed of both options.

Vertical wound closure following sacrococcygeal teratoma excision: an approachable aesthetic solution

BackgroundSacrococcygeal teratoma is a rare tumour, usually presenting in the neonatal period. The benign nature of most tumours and the high survival rates would emphasise on the importance of both cosmetic and functional outcomes.We report on our extended experience with more cases concentrating on the aesthetic outcome of vertical wound closure following excision of large irregular sacrococcygeal tumours.The study included primary cases of sacrococcygeal teratoma who were referred to our surgical team for excision. Cases of presacral tumours associated with anorectal anomalies and sacral bony defects (Currarino triad) were excluded. In all cases, we planned for a vertical midline wound closure after tumour excision. The aesthetic outcomes are evaluated concerning the vertical midline scar, buttock’s contour, and position of the anus.ResultsIn addition to twelve previously reported cases (during the period 2011 through 2016), we included another ten new consecutive cases operated during the period 2017 through 2021. Collectively, the study included 22 cases of sacrococcygeal teratoma that underwent vertical perineal wound closure after excision of the tumour. In 13 cases (those with relatively small or medium-sized tumours), the perineal wound was perfectly closed in the midline (well-hidden vertical scar in the natal cleft). For the rest of the cases (9 cases with large and/or irregular sacrococcygeal tumours), some modification was applied on the vertical linear mid-line skin closure to accommodate for skin redundancy and irregularity at the lower end of the wound, usually ending with an ‘inverted-Y’ skin closureConclusionVertical wound closure was always feasible after excision of sacrococcygeal teratomas. Even with large and irregular tumours, the vertical scar was perfectly or partially hidden within the natal cleft. Usually, there was adequate buttock development with minimal disturbance to the normal anal location within the perineum.

V-041 ENTEROCUTANEOUS FISTULA TAKEDOWN AND VENTRAL HERNIA REPAIR WITH PREPERITONEAL MESH

Abstract In this video, we present a 48-year-old otherwise healthy man with a history of perforated appendicitis status post exploratory laparotomy and appendectomy, complicated by an intraabdominal abscess requiring re-exploration and subsequent midline wound dehiscence, incisional ventral hernia, and enterocutaneous fistula managed with a drain. Plastic surgery performed a split thickness skin graft of his midline wound, and his drain was kept in place until surgery. The patient was taken to the operating room for a takedown of his enterocutaneous fistula and an open repair of his incisional ventral hernia. We entered the abdomen in the midline, far away from the fistula. After lysing omental and bowel adhesions, we identified the patient's drain entering the small bowel and exiting about 10 cm distally. We removed the drain from the small bowel and performed a small bowel resection, including the entry and exit points of the drain, and a stapled side-to-side antiperistaltic anastomosis. Preperitoneal planes were developed bilaterally, and the peritoneum was rearranged over the bowel and partially closed to the omentum. We placed a biologic mesh into the preperitoneal plane and secured it in place with transfascial sutures. We then performed a multilayer closure of the fascia and dermis and an incisional negative pressure dressing was placed over the wound. The patient was discharged on postoperative day 4 after tolerating a regular diet and having full return of bowel function. In summary, this video demonstrates several important operative techniques in our approach to this complex case.

Coverage of Midline Back Wounds with Perforator-Based Pedicled Fasciocutaneous Flaps

Background: The number of patients with midline back wounds is increasing. Midline back wounds may cause skin and soft tissue defects, resulting in cavity formation and bone or orthopedic metallic hardware exposure. These complexities complicate coverage of the wounds. This study aimed to determine whether a perforator-based pedicled (island) flap was useful for the coverage of midline back wounds.Methods: After debridement of the wound, flaps were designed, dissected and inset into the midline wounds. The donor site was closed primarily. If the wound was too large to be covered with a unilateral flap, another flap at the contralateral site was used. Immediate and early postoperative position changes were made.Results: Between May 2011 and November 2019, 13 patients with skin and soft tissue defects of the midline back underwent coverage with perforator-based pedicled fasciocutaneous flaps. All flaps survived. Though flap tip necrosis and/or wound dehiscence occurred in five patients, total flap necrosis was not observed. Immediate postoperative position change was possible, allowing the patient to avoid flap ischemia.Conclusion: The perforator-based pedicled fasciocutaneous flap can be a useful option for covering midline back wounds with skin and soft tissue defects.

Midline and off-midline wound closure methods after surgical treatment for pilonidal sinus

Midline and off-midline wound closure methods after surgical treatment for pilonidal sinus

Delayed return of urinary continence following the removal of neglected sacral shrapnel

BackgroundGlobalisation of terrorism has led to an increase in the number of injuries from the explosion of improvised explosive devices, with complications resulting from the retained shrapnel. It had been found that a third of those who sustained penetrating spinal cord injuries are from explosions. Retained foreign body in the sacral canal segment is rare, especially shrapnel presenting with urinary incontinence. Moreover, the one who had a dramatic recovery of urinary continence following removal of neglected sacral canal shrapnel. We report a case of a delayed improvement (recovery) in urinary continence following removal of neglected sacral canal shrapnel remotely aided by a pelvic floor exercise.Case presentationOur patient was a 14-year-old male who presented with a 3-year history of trauma to the lower back from an Improvised Explosive Device. He was initially associated with difficulty in walking that improved over eight months. However, the urinary incontinence persisted. He was found to be preserved with no neurological deficit in the lower limb. There was a lower back, midline wound, discharging pus. Lumbosacral imaging revealed a sacral (S2) canal Shrapnel. As a case of urinary incontinence from sacral shrapnel, he had the removal of the shrapnel, did well postoperatively, commenced on pelvic floor exercise. He became continence of urine over time.ConclusionsRetained foreign bodies in the spinal canal are associated with complications that include neurological deficit. Neglected (long-standing) sacral shrapnel with urinary incontinence is rare; moreover, the recovery of the continence with the removal of the shrapnel is aided by the commencement of pelvic floor exercise.

213 Utility of Botox Injection in Early Laparostomy Closure for Abdominal Compartment Syndrome in Acute Severe Pancreatitis – a Case Report

Abstract Acute pancreatitis can cause significant visceral oedema due to fluid resuscitation, paralytic ileus and ascites with raised intra-abdominal pressure(IAP) and abdominal compartment syndrome (ACS >20mmHg). Failure of conservative management is an indication for decompressive laparostomy. Early fascial closure is the priority following laparostomy to reduce morbidity, mortality, and the risk of enteric fistulation. Chemical component separation with Botulinum toxin injection is proven to be of benefit prior to elective complex ventral hernia repairs and has been reported in laparostomy closure. We report our use of Botox to assist with vacuum and mesh-assisted early closure of laparostomy in a patient with acute severe pancreatitis. A 29-year-old male was admitted with severe alcohol induced pancreatitis. He developed acute respiratory distress and was intubated and ventilated. On day 14 of admission, he developed raised IAP of >40mmHg with multiorgan dysfunction and underwent laparostomy and application of Abthera© vacuum assisted negative pressure dressing. 3 days later, the dressing was replaced and a prolene mesh was sutured to the fascial margins to allow approximation of the wound to prevent retraction of the rectus sheath. He underwent further dressing change with trimming of mesh on day 6 and received 300U of Botulinum toxin injection into the abdominal musculature bilaterally. On day 7 following botox injection, the mesh was excised, and the midline wound was closed without tension. He remained stable with normal IAP and no wound related complications. Chemical component separation with Botulinum toxin may be a valuable adjunct in early closure of laparostomy.

Limberg Flap Versus Primary Midline Wound Closure in Treatment of Chronic Pilonidal Sinus Disease

Objective: Current study aims to compare the Limberg flap technique with primary midline wound closure to treat the chronic pilonidal sinus disease. Study design: A comparative study was done in Surgery Department Sir Ganga Ram Hospital Lahore from January 2020 to September 2021 Method: The sample size for the study is 60 patients who were regularly visiting the hospital due to PS disease. All the patients were divided into two groups A and B. Group A had 30 patients treated with the Limberg flap method and group B had 30 patients treated with primary midline wound closure. Before starting the treatment a brief description of the treatment was given to all patients and consent was signed from all participants. The final decision for treatment was decided by the team of senior surgeons as well as with help of the patient's own choice. Limberg flap and primary midline wound closure (PMC) were applied to patients who regularly followed the instruction for chronic pilonidal sinus treatment. Primary midline closure was applied on patients who had a cosmetic concern and did not have a recurrence problem. Results: Total 60 patients were divided into two groups, Group A (Limberg flap) had 30 patients in which 25 (83%) were males and 5 (16.6%) females. The mean age for this group was 25 ± 5.00 years. The patients without a previous history of pilonidal sinus disease (primary case) was 17 (56.6%) and the recurrence case was 13 (14.3%). Group B (primary midline wound closure) had 30 patients in which 18 (60%) were males and 12 (40%) females. The mean age for this group was 28 ± 3.00 years. The patient without a previous history of pilonidal sinus disease (primary case) was 28 (93.3%) and the recurrence case was 2 (6.6%). The comparison of 3rd-week outcomes shows that in group A 25 (83,3%) patients had painless walking, 23 (76.6%) patients start their routine work and 26 (86.6%) patients had treatment satisfaction. In group B 21 (70%) patients reported painless walking, 18 (60%) patients started their routine activity and 22 (73.3%) patients shows satisfaction with treatment. Conclusion: Hence we concluded that a better improvement percentage was measured high in group A (Limberg flap) than group B (PMC). Therefore limberg flap is better technique to treat the chronic pilonidal sinus disease. Keywords: chronic Pilonidal Sinus, primary midline wound closure (PMC), Limberg flap

Endoscopic Mini/Less Open Sublay Repair for Two Large Abdominal Incisional Hernias in a Midline Wound and Stoma Closure Site

Endoscopic Mini/Less Open Sublay Repair for Two Large Abdominal Incisional Hernias in a Midline Wound and Stoma Closure Site

Colonic diverticulum in a dog - a case report

The objectives of the current case report are to describe and report the diagnostics and surgical treatment of colonic diverticulum in a dog. A 13-year-old intact male Labrador retriever, suffering from the inability to defecate for 10 days, was diagnosed with a mass between the colon and the urinary bladder, filled with faeces. The diagnosis of a colonic diverticulum was obtained using plain abdominal radiography, ultrasonography, cystography and irigography. Native and contrast abdominal radiography and ultrasonography detected an abdominal mass with a diameter of 9 cm, filled with faeces, connected to the descending colon, and an enlarged prostatic gland. The dog was treated surgically with orchiectomy, exploratory celiotomy, partial resection of the colonic diverticulum wall, followed by reconstruction of the colon using the wall of the colonic diverticulum as a flap. The dog defecated 24 hours after surgery. On the 5th postoperative day, a wound infection was observed (redness, serous discharge from the ventral midline wound). The functional outcome was satisfactory. To the best of our knowledge, such a case report has not been reported before.

Risk factors for incisional hernia according to different wound sites after open hepatectomy using combinations of vertical and horizontal incisions: A multicenter cohort study.

Background: Although several risk factors for incisional hernia after hepatectomy have been reported, their relationship to different wound sites has not been investigated. Therefore, this study aimed to examine the risk factors for incisional hernia according to various wound sites after hepatectomy.Methods: Patients from the Osaka Liver Surgery Study Group who underwent open hepatectomy using combinations of vertical and horizontal incisions (J‐shaped incision, reversed L‐shaped incision, reversed T‐shaped incision, Mercedes incision) between January 2012 and December 2015 were included. Incisional hernia was defined as a hernia occurring within 3 y after surgery. Abdominal incisional hernia was classified into midline incisional hernia and transverse incisional hernia. The risk factors for each posthepatectomy incisional hernia type were identified.Results: A total of 1057 patients met the inclusion criteria. The overall posthepatectomy incisional hernia incidence rate was 5.9% (62 patients). In the multivariate analysis, the presence of diabetes mellitus and albumin levels <3.5 g/dL were identified as independent risk factors. Moreover, incidence rates of midline and transverse incisional hernias were 2.4% (25 patients), and 2.3% (24 patients), respectively. In multivariate analysis, the independent risk factor for transverse incisional hernia was the occurrence of superficial or deep incisional surgical site infection, and interrupted suturing for midline incisional hernia.Conclusions: Risk factors for incisional hernia after hepatectomy depend on the wound site. To prevent incisional hernia, running suture use might be better for midline wound closure. The prevention of postoperative wound infection is important for transverse wounds, under the presumption of preoperative nutrition and normoglycemia.

German National Guideline on the management of pilonidal disease: update 2020.

BackgroundThe present German National Guideline is an updated version of previous Guideline published in 2014. It aims to compare various treatment methods and to assist physicians with evidence-based recommendations.MethodsSystemic literature review.ResultsThree types of disease manifestation could be differentiated: asymptomatic disease, an acute abscess, and the chronic pilonidal disease. At present, there is no treatment method fulfilling all desired criteria: simple, painless procedure associated with rapid wound healing, and low recurrence rate. Thus, treatment modality should be tailored to disease manifestation and extent.ConclusionAsymptomatic pilonidal disease should not be treated. A pilonidal abscess should be unroofed. After resolution of the acute inflammation, the disease should be treated definitely. As for today, sinus excision is the standard treatment of the chronic pilonidal disease. Wide excision and open treatment of chronic disease is a safe procedure which, however, leads to prolonged secondary healing and time off-work, as well as to considerable recurrence rate. The extent of excision should be as limited as possible. Excision and midline wound closure is associated with impaired outcomes. Today, it has become obsolete. Minimally invasive procedures (e.g., pit picking surgery) represent a treatment option for chronic pilonidal disease. However, the recurrence rate is higher compared to excision procedures. Nevertheless, they may be used for small primary disease. Off-midline procedures should be used for disease not suitable for minimally invasive treatments. The Limberg flap and the Karydakis procedure are two best described methods which are associated with similar short- and long-term results.

Case Report: Cold Atmospheric Plasma as a Treatment Option for Superficial Wound Healing Disorders after Heart Transplantation

Introduction Superficial wound healing disorders (SWD) after heart transplantation (HTx) remain challenging due to continuous immunosuppression. Cold atmospheric plasma (CAP) is a partially ionized plasma, which has shown to have a beneficial effect on skin regeneration and microbial inactivation. The aim of this case report is to demonstrate an example of successful use of CAP as a supportive treatment for SWD after HTx. Case Report We present our single-center experience of two female patients (18 and 39 years) with SWD three and eight weeks after HTx. Both patients were transplanted due to dilatative cardiomyopathy and immunosuppression consisted of a combination of tacrolimus, mycophenolate mofetil and steroids for both patients. HTx was performed according to institutional guidelines and the early postoperative course was uneventful. Starting on the day of SWD diagnosis, CAP was performed as a standard therapy scheme of 5 minutes per treatment twice weekly for a total of three weeks. Both patients were schooled for adequate wound management including daily change of wound dressings.Both SWD presented as a superficial apical dehiscence of the midline incision and wound swabs showed no growth throughout the treatment. After three weeks of CAP treatment, the wounds were completely epithelialized and showed no more signs of infection without need for additional local or systemic antibiotic or surgical treatment. There were no adverse side effects of CAP therapy observed and the therapy was tolerated well by both patients. Summary CAP showed to be a safe and feasible treatment option for superficial SWD despite immunosuppressive therapy with no need for further surgery, anti-infective therapy or reduction of immunosuppression. Due to convincing results, CAP could be a safe treatment option for SWD after HTx and should be investigated further.

Limited subcatenous secondary sinuses excision in complex pilonidal sinus disease.

Introduction Pilonidal sinus disease (PSD) is a simple chronic inflammatory condition . Many surgical procedures used to treat pilonidal disease. In this study we represent a case series for treating complex PSD by Subcutaneous Sinusectomy and cystectomy.Patients and methods: Thirty five patients with complex PSD according Tezel classification were enrolled in the study. Marking of eccentric openings then an elliptical incision was done 1 cm from midline with 0.5 cm depth , all cases has a lateral remote openings from the midline we start dissection around the opening itself by a narrow ellipse then the side tracks palpated and we started subcutaneous dissection of the track then randveau dissection from the main midline wound to meet each other to extract the side track as one peace with main cyst. Results he studied group was 35 patients , 28 (80%) were males , 7 (20%) were females the mean age was 26±5.44 years with range 18-43 years. The mean operative time was 25.71 ±5.21 minutes with range 20-45 minutes, while the hospital stay was 28±5.32 hours with range 24-36 hours Recurrence occurred in 2 patients 5.71%. Primary non healing was the most common complication 5.71% . Conclusion: Subcutaneous Sinusectomy and cystectomy is a feasible and accepted option for management of complex PSD with a fair recurrence rate, short hospital stay and early return to work.

Outcome of abdominal binder in midline abdominal wound Dehiscence in terms of pain, psychological satisfaction and need for reclosure.

Objective:To assess the role of abdominal binder in patients with midline wound dehiscence after elective or emergency laparotomy in terms of pain, psychological satisfaction and need for reclosure.Methods:It was a comparative study done at EAST Surgical Ward of Mayo Hospital, Lahore from 1st January 2018 to 31st December 2019. One hundred and sixty-two (162) patients were included in this study with post-operative midline abdominal wound dehiscence and after informed consent by consecutive non probability sampling technique. Patients were divided into two groups by lottery method into eighty-one patients each. Group-A included patients where abdominal binder was applied and Group-B included patients without abdominal binder. In both groups pain score, psychological satisfaction and need for reclosure was assessed and compared.Results:Patients with abdominal binder shows significantly less pain (P value =0.000) and more psychological satisfaction (P value = 0.000) as compared to the patients where abdominal binder was not used. However, there was no difference in reducing the need for reclosure in patients who use abdominal binder (P value = 0.063).Conclusion:Although abdominal binder helps in reducing the pain and improving the psychological satisfaction in patients with midline abdominal wound dehiscence yet it doesn’t help in healing of wound and reclosure of the dehisced abdominal wound is needed.