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On-ward surgical management of wound dehiscence: report of a single neurosurgical center experience and comparison of safety and effectiveness with conventional treatment

Abstract

The early identification and optimized treatment of wound dehiscence are a complex issue, with implications on the patient’s clinical and psychological postoperative recovery and on healthcare system costs. The most widely accepted treatment is surgical debridement (also called “wash out”), performed in theater under general anesthesia (GA), followed by either wide-spectrum or targeted antibiotic therapy. Although usually effective, in some cases, such a strategy may be insufficient (generally ill, aged, or immunocompromised patients; poor tissue conditions). Moreover, open revision may still fail, requiring further surgery and, therefore, increasing patients’ discomfort. Our objective was to compare the effectiveness, costs, and patients’ satisfaction of conventional surgical revision with those of bedside wound dehiscence repair. In 8 years’ time, we performed wound debridement in 130 patients. Two groups of patients were identified. Group A (66 subjects) underwent conventional revision under GA in theater; group B (64 cases) was treated under local anesthesia in a protected environment on the ward given their absolute refusal to receive further surgery under GA. Several variables—including length and costs of hospital stay, antibiotic treatment modalities, and success and resurgery rates—were compared. Permanent wound healing was observed within 2 weeks in 59 and 55 patients in groups A and B, respectively. Significantly reduced costs, shorter antibiotic courses, and similar success rates and satisfaction levels were observed in group B compared with group A. In our experience, the bedside treatment of wound dehiscence proved to be safe, effective, and well-tolerated.

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Author information

Correspondence to Roberto Colasanti.

Ethics declarations

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Ethical approval

All aspects of this retrospective study were approved by the local ethics committee, and for this type of study, formal consent is not required.

Conflict of interest

The authors declare that they have no conflict of interest.

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Di Rienzo, A., Colasanti, R., Liverotti, V. et al. On-ward surgical management of wound dehiscence: report of a single neurosurgical center experience and comparison of safety and effectiveness with conventional treatment. Neurosurg Rev 43, 131–140 (2020). https://doi.org/10.1007/s10143-018-1022-5

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Keywords

  • Cranial
  • Dehiscence
  • Outpatient
  • Spine
  • Surgical
  • Wound