Prevention Of Wound Dehiscence Research Articles

Rectus Muscle Flap-augmented Closures in Wide-gap Exstrophy Bladder.

Wound dehiscence is one of the main complications in complete primary repair of exstrophy (CPRE). In our pediatric urology unit, we have switched to the use of inferior epigastric artery based rectus abdominis flap cover for abdominal wall closure in addition to measures like osteotomy and postoperative hip spica. to assess the efficacy of Recus abdominis flap in prevenion of wound dehisence. This study was conducted from June 2014 to June 2021 comparing two groups of the patients; group I consisted of thirty patients of CPRE with rectus flap repair of abdominal wall (CPRE-RF) and group II consisted of thirty patients with CPRE without rectus flap. Clinical and surgical details, including the outcome with regards to wound dehiscence and continence, were recorded. The mean age of the patients in CPRE-RF was 5 months and that with only CPRE was 4.6 months. Mean pubic diastasis in Group l was 4.8± 1.07 cm and that of Group II was 4.6±1.3 cm. None of the patients in CPRE-RF had wound dehiscence or bladder prolapse while as 6 patients in CPRE alone had wound dehiscence and 1 had bladder prolapse. This difference was statistically significant. Primary bladder continence was achieved in 4 patients in CPRE-RF and 3 patients in CPRE group. Hypospadias had almost similar occurrence in the two groups. One patient in each group had bladder neck fistula. Use of rectus muscle flap in complete Primary Repair ofExtrophy bladder helps in prevention of wound dehiscence and contributes in achievement of final goal of continence in wide gap pubic diatasis.

Pathophysiology, Risk Factors, and Prevention of Wound Dehiscence Following Dermatologic Procedures

Skin cancer is the most common malignancy in the United States and has been increasing in incidence, affecting approximately one in five Americans. As the number of skin cancers have increased, so have the number of dermatologic procedures including biopsies and excisions. Behind surgical site infection, wound dehiscence is the second most common postoperative complication of dermatologic procedures. There are many preoperative, intraoperative, and postoperative risk factors for wound dehiscence. The current literature on the risk factors of dehiscence within the field of dermatology is scarce. To our knowledge, there have not been any comprehensive reviews on this topic. Our research article aims to serve as a comprehensive and concise review with the goal of educating providers and increasing awareness of the risk factors associated with wound dehiscence.

Efficacy of prophylactic retention suture in prevention of wound dehiscence in emergency exploratory laparotomy- A prospective study

Efficacy of prophylactic retention suture in prevention of wound dehiscence in emergency exploratory laparotomy- A prospective study

A randomized controlled study to compare the efficacy of hughes abdominal repair with conventional abdominal closure-to reduce the incidence of incisional hernias in Indian population

Background: Incisional hernia forms the most common delayed morbidity following midline laparotomy surgeries- causing mental trauma to the patient impairing their quality of life and scars the name and fame of the surgeon. So, the need for possible attributes on surgeon’s aspect to prevent the incisional hernia is the need of the hour. We planned a randomized controlled trial to compare two different abdominal closure techniques to reduce the incidence of Incisional hernia following midline laparotomy incisions. We advocated Hughes abdominal repair which includes a series of two horizontal and two vertical mattresses within single suture whereby the tension load of suture is distributed both along and across the suture line.Methods: 1:1 Randomized controlled trial in which the patient is blinded and obviously operating surgeon is non-blinded. Evaluating examiner and radiologist are blinded.100 patients who underwent emergency and elective midline laparotomies were enrolled in the study and intra-operatively randomized into two groups in 1:1 pattern. Ethical clearance obtained from the Institutional ethical committee. The primary outcome measure is the incidence of burst abdomen at the end of 15 days by the evaluating surgeon (non-operated surgeon who is blinded). The secondary outcome is the incidence of incisional hernia at the end of one year-evaluated by detailed clinical examination with radiological proof using CT abdomen.Results: The incidence of incisional hernia is significantly low in Hughes abdominal repair than conventional abdominal closure.Conclusions: Hughes abdominal wall closure is superior to conventional closure in both emergency and elective laparotomy cases, in prevention of wound dehiscence and Incisional hernias later. Present study encourages us that Hughes abdominal wall repair is comparable to mesh repairs. This study needs to be continued further to a vast sample size to perfectly assess the statistical significance.

Optimal tissue tension for secure laparoscopic knots

Security and strength of a knot are main concerns of the surgeon since last 4000 years. The advancement of endoscopic and minimally invasive surgery in last few decades had a significant influence on a knot tying. The most difficult methods of a knot tying are performed during endoscopic procedures, in which the surgeon execute instrumentation from outside the body without palpation of organs and three-dimensional vision. In addition, laparoscopic instruments due to friction in transmission mechanism have very poor force feedback. This results into difficulty in applying the appropriate grasping force to the tissue, resulting in slippage or damage to the tissue. Our hypothesis highlights the need of tissue approximation at the 'optimum tissue tension' sufficient to resist the slippage of suture/clip without strangulation. The purpose of suture is to maintain an approximation of the tissue until healing progresses to the point where artificial support is no longer necessary for the wound to resist normal stress. When the approximation is too tight, tension in tissue leads to diminished blood supply resulting into the necrosis. Various tissues need different blood supply and different tissue pressure for optimum healings. Proposed hypothesis helps to improve the feedback of current knot pushers or clip applicators used in laparoscopic surgery using optimum tissue tension. Tissue approximation at an optimal tissue tension translates into the secure laparoscopic knot/clip application resulting in prevention of wound dehiscence, anastomosis leak, and secondary haemorrhages.

Prevention of wound dehiscence in palatal surgery by preoperative identification of group A Streptococcus and Staphylococcus aureus

The goal of this study was to assess the effectiveness of the selective use of prophylactic antibiotics after preoperative microbiological analysis of the oral and nasal cavity. In a retrospective study of wound infections after palatal surgery, 124 patients were included (134 procedures) who underwent all types of corrections of the palate. Standardized cultures from nasal and oropharyngeal mucosa were routinely obtained from all patients admitted for palatal surgery in the week prior to operation. According to existing protocol, every patient revealing group A Streptococcus from the nose or the throat received intravenous amoxicillin-clavulanate perioperatively. The postoperative finding of the combination of partial or complete wound dehiscence, pus, and fever was considered evidence of infection. Cultures from dehisced wounds were subsequently analyzed. Out of 134 procedures performed with this selective use of antibiotics, an infection rate of 6.0% (eight procedures) was noted. None of the patients receiving the amoxicillin-clavulanate prophylaxis showed infection. Patients showing infection revealed preoperative cultures with a diverse flora. Postoperative cultures of these patients showed group A Streptococcus and Staphylococcus aureus as the main pathogens. Despite the retrospective design and limited number of infected patients, cautious conclusions are warranted. When routine cultures from the nasal and oropharyngeal mucosa are obtained preoperatively, infection rate may be reduced by selective use of antibiotics against group A Streptococcus and Staphylococcus aureus.

Factors in the Prevention of Wound Dehiscence During Pneumatic Retinopexy

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Prevention of wound dehiscence by use of stainless-steel retention sutures.

Through-and-through wire stay sutures of stainless steel were used to reinforce the closure of the abdominal incision in 835 patients, mostly after operations on the upper abdomen. In 893 other patients who had mostly lower abdominal incisions stay sutures were not used. In each of these 2 groups there were 3 cases of dehiscence. The incidence of this complication was about the same (0.36% and 0.33%) in the two groups. This is considered significant because several factors make for weakness of the abdominal wall after incisions in the upper abdomen. The results are therefore interpreted to mean that the stay sutures used for closure after upper abdominal operations appreciably reduced the danger of dehiscence.