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Wound Dehiscence and Role of Delayed Primary Closure in Gynaecological Oncology

  • Anirudha Rohit Podder
  • G. S. Jyothi
Original Article
  • 19 Downloads

Abstract

Aim

To study the role of delayed primary closure of the abdomen in preventing wound dehiscence in women undergoing surgery for gynaecological malignancies.

Materials and Methods

Between 01 January 2017 and 30 June 2017, 22 patients underwent laparotomy at our institute. Primary closure of abdomen was done with a suction drain placed in subcutaneous space. Between 01 July 2017 and 31 December 2017, 23 patients underwent laparotomy and for those patients who had at least one of the following conditions—diabetes mellitus, obesity (subcutaneous fat > 2.5 cm), infective foci (e.g. tuboovarian abscess), delayed primary closure of the abdomen was followed. The wound was closed after a week.

Results

There were six cases of wound dehiscence in the first group. The duration of hospital stay exceeded 1 month from the day of laparotomy in all the six patients. In the second group, seven patients underwent delayed primary closure. Closure was done after a week, with a suction drain in situ. The wound healed well in all patients. All seven patients were discharged within 15 days of laparotomy.

Discussion

Patients with malignancy can have poor healing due to a variety of reasons. It can be due to neoadjuvant chemotherapy, previous radiotherapy, and co-morbid factors like obesity, diabetes, anaemia. Delayed primary closure involves closure of the rectus sheath following laparotomy, but the skin is closed after the blood supply to the skin and patient’s general condition have both been improved; this will certainly lead to better wound healing. It helps in reducing duration of hospital stay, treatment costs, antibiotic usage and is less frustrating for the surgeon and the patient. However, the risk of future hernia and intestinal obstruction due to post-operative adhesions remains.

Conclusion

There are very little published data, about the benefits of delayed primary closure, but a few studies which are available do concur that this technique should be used more often. It should be practiced in those patients who are at high risk of wound dehiscence, since it reduces the duration of hospital stay, use of antibiotics, and treatment costs.

Keywords

Delayed primary closure Wound dehiscence Corset dressing Burst abdomen SSI 

Notes

Compliance with Ethical Standards

Conflict of interest

Dr. Anirudha Rohit Podder declares that he has no conflict of interest. Dr. GS Jyothi declares that she has no conflict of interest.

Ethical Approval

This article does not contain human participants or animal studies by any of the authors.

References

  1. 1.
    Fleischer GM, Rennert A, Ru¨hmer M. Infected abdominal wall and burst abdomen. Chirurg. 2000;71:754–62.CrossRefPubMedGoogle Scholar
  2. 2.
    Walming S, et al. Retrospective review of risk factors for surgical wound dehiscence and incisional hernia. BMC Surg. 2017;17:19.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Choudhary SK, Choudhary SD. Mass closure versus layer closure of abdominal wound: a prospective clinical study. J Indian Med Assoc. 1994;92:229–32.Google Scholar
  4. 4.
    Podder AR, Jyothi GS. Burst abdomen: a preventable complication in gynecological oncology. Indian J Gynecol Oncol. 2016;14:58.CrossRefGoogle Scholar
  5. 5.
    Deshmukh SN, Maske AN. Mass closure versus layered closure of midline laparotomy incisions: a prospective comparative study. Int Surg J. 2018;5(2):584–7.CrossRefGoogle Scholar
  6. 6.
    Banu A, Anand M, Nagi N. White Coats as a Vehicle for Bacterial Dissemination. J Clin Diagn Res. 2012;6(8):1381–4.PubMedPubMedCentralGoogle Scholar
  7. 7.
    Thapa S, Sapkota SB. Bacteriological assessment of stethoscopes used by healthcare workers in a tertiary care centre of Nepal. BMC Res Notes. 2017;10:353.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Payne WG, et al. Wound healing in patients with cancer. Eplasty. 2008;8:e9.PubMedPubMedCentralGoogle Scholar
  9. 9.
    Gieringer M, Gosepath J, Naim R. Radiotherapy and wound healing: principles, management and prospects. Oncol Rep. 2011;26:299–307.PubMedGoogle Scholar
  10. 10.
    Guo S, DiPietro LA. Factors affecting wound healing. J Dent Res. 2010;89(3):219–29.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Chiang RA, Chen SL, Tsai YC. Delayed primary closure versus primary closure for wound management in perforated appendicitis: a prospective randomized controlled trial. J Chin Med Assoc. 2012;75(4):156–9.CrossRefPubMedGoogle Scholar
  12. 12.
    Verdam FJ, et al. Delayed primary closure of the septic open abdomen with a dynamic closure system. World J Surg. 2011;35(10):2348–55.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Nasib G, Shah IS, Bashir EA. Laparotomy for peritonitis: primary or delayed primary closure. J Ayub Med Coll Abbottabad. 2015;27(3):543.PubMedGoogle Scholar

Copyright information

© Association of Gynecologic Oncologists of India 2018

Authors and Affiliations

  1. 1.Department of Obstetrics and GynaecologyRamaiah Medical CollegeBengaluruIndia

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