Rahul Anand Arya, Naveen Kumar
Wound dehiscence or acute wound failure may lead to significant postoperative morbidity and mortality. It has an incidence of 0.25-3.0% and associated mortality of 20-25%. The aim of the present study to evaluate the risk factors and their management ina patient of wound dehiscence following emergency laparotomy.
Material and methods: A prospective observational study evaluated 60 patients who underwent emergency laparotomy were studied for risk factors leading to abdominal wound dehiscence, their clinical presentation and their ultimate outcome from 1st June 2018 to 1st May 2019.
Observations and results: A total of 60 patients evaluated in the study underwent emergency laparotomy, out of which 13.33% patients had wound dehiscence and mortality among patients with burst abdomen was 25%. The risk factors observed among patients with burst abdomen were low body mass index, low hemoglobin and albumin, renal diseases, COPD, presence of wound infection,infection at remote site, postoperative coughing, vomiting, abdominal distension or mechanical ventilation (p<0.05). Factors that did not turn out to be significant were age>65, male sex, DM, HTN, preoperative hospitalization >24hours, previous abdominal surgery, jaundice, smoking, duration of surgery >2.5 hours. Two risk factors reported to cause burst abdomen that is emergency surgery and technique of abdomen closure were standardized for all patients. Average postop day at which dehiscence occurred was 8.125(ranges 5-11 day. 5 (out 0f 8) patients with burst abdomen who underwent repeat surgery of them 2 (out of 5) expired, 2 had normal abdominal wound healing and 1 had re-dehiscence and underwent incisional hernioplasty and 3 patients were managed conservatively
Conclusion: Wound dehiscence often reflects an error of judgment on the part of surgeon, a thorough pre-operative assessment, identification and removal if possible is essential to minimize incidence of wound dehiscence and associated mortality.