Treatment Of Wound Dehiscence Research Articles

An abdominal wound dehiscence of emergency explorative laparotomy and their management at tertiary care centre: an observational study

Background: Wound dehiscence is a very troublesome sequel of impaired wound healing. Despite of medical advances frequency of wound dehiscence in emergency laparotomy remains high due to multiple factors together predisposes. Better understanding of common mechanisms and highly contributing factors will help to keep high risk patients under strict surveillance to reduce the incidence of wound dehiscence. Methods: The observational study was carried out in 167 patients of above 14 years age at the department of General surgery, SMIMER hospital, Surat between November 2018 to October 2020 Result: 22.15% patients developed wound dehiscence, mean age in dehiscence group was 39.27±9.65 years. Abdominal pain was found in all the patients 100% followed by vomiting 28.74% and fever 13.17%. However, Fever (2.37±1.95 days vs 1.55±1.78 days) and Abdominal distention (1.05±1.06 days vs 0.47±0.87) have statistical significance between Wound Dehiscence and No Wound Dehiscence regarding chief complaints. As a treatment of wound dehiscence, 2 (5.40%) had Re-exploration and 6 (16.21%) had Re-exploration and Tension Suturing in complete wound dehiscence patient group and 29 (78.39%) had Secondary suturing found in partial wound dehiscence. 5.40% of mortality found in Wound Dehiscence group. Conclusions: Significant risk factors for abdominal wound dehiscence identified in this study are presenting complains like fever and abdominal distension, pre-operative hypoalbuminemia, pre-operative anemia, leucocytosis, renal dysfunction, intra-abdominal sepsis. Use of subcutaneous negative tube is protective for the condition. Hollow viscus perforation patients showed higher vulnerability for wound dehiscence.

Outcomes of Wound Dehiscence after Penetrating Keratoplasty and Lamellar Keratoplasty.

Objective To investigate the incidence, causes, occurrence time, and range of wound and outcomes of wound dehiscence in patients treated by penetrating keratoplasty (PK) or lamellar keratoplasty (LK). Methods We retrospectively reviewed medical records of keratoplasty in Shandong Eye Hospital from January 2006 to June 2017. Thirty-one eyes of 30 patients had sustained wound dehiscence (WD) after surgical treatment. The surgical type, causes, occurrence time, extent of the wound, treatment, and outcomes were recorded. Results The study population consisted of 26 men and 4 women. The mean age at the occurrence of WD was 44.6 years old (range: 12–78 years), and the mean time from keratoplasty to WD was 45.9 months (range: 1–204 months). WD occurred in 23 eyes (23/1385, 1.66%) after PK and 8 eyes (8/1632, 0.49%) after LK (p < 0.05). Twenty-seven eyes (27/31, 87.0%) had trauma-induced dehiscence. The mean range of dehiscence was 5.5 o'clock. The vision ranged from 20/50 to light perception after wound suture. The eyes receiving LK had fewer serious complications than PK. Conclusions Compared with LK, PK seems to be more prone to result in wound dehiscence. The WD after LK may be less severe. The visual acuity after treatment of WD can be worse in the eyes with PK than LK.

Traumatic wound dehiscence after corneal keratoplasty.

To assess patient characteristics, risk factors, outcomes, and the treatment of wound dehiscence (WD) in patients after corneal keratoplasty. Retrospective chart review of 11 eyes of 11 patients with corneal grafts who underwent repair of WD from January 1, 2004 to December 31, 2012 at Hospital Oftalmologico de Brasilia. Eight (72.7%) patients were men and three were women. Six (54.5%) patients had deep anterior lamellar keratoplasty (DALK) and 5 had penetrating keratoplasty. The mean age at trauma was 31.1 years. The mean time from corneal keratoplasty to WD was 12.82 months (range, 3-33 months). The mean best-corrected visual acuity of patients before trauma was 20/60 (0.48 logMAR) and after final treatment was 20/160 (0.90 logMAR) (P=0.15). In one case, visual acuity decreased to no light perception because of retinal detachment and phthisis bulbi. Accidental blunt trauma and fall were the most common causes of WD. Patients who undergo corneal keratoplasty have a life-long risk of WD. The full-thickness rupture at the graft-host junction in our study suggests that the junction remains vulnerable, even following DALK, and can rupture with trauma. In our series, depending upon the severity of the trauma, postkeratoplastic WD can be associated with a good visual prognosis.

Wound Therapy Linked With Complications

Robert Finn is with the Los Angeles bureau of Elsevier Global Medical News. The Food and Drug Administration has warned health care providers and patients to be vigilant for potentially life-threatening complications with the use of negative-pressure wound-therapy devices. The agency issued the official notification late last year after receiving reports of 6 deaths and 77 injuries associated with the devices. “Most of the deaths reported to FDA occurred at home or in a long-term care facility,” the notice stated. Bleeding was the most serious complication and involved in all the deaths and 17 of the injuries, said the FDA, but infection played a role in 27 reports. The infections arose from the original open wound or dressing pieces retained in the wound. Overall, 32 of the injuries involved retention of foam dressing pieces. Most of those patients required surgical procedures, wound debridement, and treatment of wound dehiscence as well as additional hospitalization and antibiotic therapy. The FDA's notification included a list of wound types and conditions for which negative pressure wound therapy (NPWT) is contraindicated. The agency also provided a list of risk factors that health care providers should consider before using NPWT (see sidebar). “In the appropriate wounds and in the appropriate areas,” NPWT is still useful, Paul Y. Takahashi, MD, CMD, of the Mayo Clinic (Rochester, Minn.) said in an interview. “But I think we have to be pretty cautious. It's still an FDA-approved device,” he said. “It still can help, particularly with preventing amputations. It can help in some situations in which a flap or a skin graft is not appropriate. And it certainly can still be beneficial for wounds that are not healing. But I think you really have to be well trained in using the negative pressure device, and when you remove it … make sure it's well observed, make sure things are healing in nicely and that you're not having excess bleeding.” One issue is that complications can go unnoticed in NPWT-treated wounds, Dr. Takahashi said. Unlike standard wound dressings, NPWT's may not be changed for 3 or 4 days, masking any problem. Staff and patients should be alert for certain problem signs, Dr. Takahashi said. The edges of the wound should maintain a nice pink color. It's time to become concerned when the edges start turning red or the area becomes painful. Other concerning symptoms include fevers, chills, and changes in blood pressure. “There is nothing really surprising here if you know the literature,” commented David Thomas, MD, CMD, a professor of geriatric medicine at Saint Louis University. “It is important to understand that NPWT is a medical device, which only has to be approved by the FDA for safety and not for effectiveness as required for drugs.” Dr. Thomas noted that NPWT, which is expensive, has been widely adopted with very little clinical trial data on effectiveness or adverse outcomes. “Based on current literature reviews, it is not superior to other wound therapy choices,” he said. “We need well-designed clinical trials to determine the proper place for NPWT.” The full text of the FDA's notification is at www.fda.gov/MedicalDevices/Safety/AlertsandNotices/PublicHealthNotifications/ucm190658.htm. ▸ Necrotic tissue with eschar present. ▸ Untreated osteomyelitis. ▸ Nonenteric and unexplored fistulas. ▸ Malignancy in the wound. ▸ Exposed vasculature. ▸ Exposed nerves. ▸ Exposed anastomotic site. ▸ Exposed organs. Source: Food and Drug Administration

Wound Dehiscence After Penetrating Keratoplasty

To describe the causes, clinical characteristics, and treatment of wound dehiscence in patients after penetrating keratoplasty (PK). A retrospective chart review was completed, evaluating patients seen at Bascom Palmer Eye Institute between 1989 and 2001. All dehiscence occurred at the graft-host junction with an average of 5 hours of dehiscence, but no site preference was identified. Dehiscence occurred because of trauma (53%), suture-related complications (27%), infectious keratitis (8%), and spontaneous wound separation (12%). Twelve patients had either intraocular lens dislocation or expulsion; 42 patients underwent primary repair; 7 patients underwent primary PK; and 1 patient underwent primary evisceration. Surgical details were unavailable for 1 patient. Final visual acuity ranged from 20/20 to no light perception. Acuity was unavailable for 2 patients. Visual acuity was 20/200 or better in 23 patients (47%) and less than 20/200 in 26 patients (53%). Two patients (4%) had no light perception. The visual acuity of 13 patients (27%) was 20/40 or better at their last clinic visit. Comparison of predehiscence and postdehiscence visual acuity showed that 23 eyes (54%) had comparable vision after dehiscence, 11 eyes (25%) had improved vision, and 9 eyes (21%) had worsening of vision. These observations show that graft dehiscence can occur for a variety of reasons after PK, including trauma, infectious keratitis, suture failure, or spontaneous wound separation. The graft-host interface remains vulnerable after corneal transplant and is a potential area for wound dehiscence even many years after keratoplasty. Nevertheless, comparable or even improved vision is possible after wound dehiscence.