Factors influencing wound dehiscence

Riou, Jean-Pierre A.; Cohen, Jon R.; Johnson, Houston

doi:10.1016/0002-9610(92)90014-i

Cited by 254 publications

(194 citation statements)

References 19 publications

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“…Postoperative wound complications, such as infection, dehiscence, and formation of haematoma or seroma, are common complications of surgical procedures1, 2, particularly among patients with risk factors such as obesity and diabetes3, 4, 5. Postoperative wound complications may lead to increased healthcare costs due to prolonged inpatient stay, repeat surgery and the need for increased follow‐up6, 7.…”

Section: Introductionmentioning

confidence: 99%

Meta-analysis of negative-pressure wound therapy for closed surgical incisions

Hyldig

Birke-Sørensen

Kruse

et al. 2016

British Journal of Surgery

199

172

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BackgroundPostoperative wound complications are common following surgical procedures. Negative‐pressure wound therapy (NPWT) is well recognized for the management of open wounds and has been applied recently to closed surgical incisions. The evidence base to support this intervention is limited. The aim of this study was to assess whether NPWT reduces postoperative wound complications when applied to closed surgical incisions.MethodsThis was a systematic review and meta‐analysis of randomized clinical trials of NPWT compared with standard postoperative dressings on closed surgical incisions.ResultsTen studies met the inclusion criteria, reporting on 1311 incisions in 1089 patients. NPWT was associated with a significant reduction in wound infection (relative risk (RR) 0·54, 95 per cent c.i. 0·33 to 0·89) and seroma formation (RR 0·48, 0·27 to 0·84) compared with standard care. The reduction in wound dehiscence was not significant. The numbers needed to treat were three (seroma), 17 (dehiscence) and 25 (infection). Methodological heterogeneity across studies led to downgrading of the quality of evidence to moderate for infection and seroma, and low for dehiscence.ConclusionCompared with standard postoperative dressings, NPWT significantly reduced the rate of wound infection and seroma when applied to closed surgical wounds. Heterogeneity between the included studies means that no general recommendations can be made yet.

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Section: Introductionmentioning

confidence: 99%

Meta-analysis of negative-pressure wound therapy for closed surgical incisions

Hyldig

Birke-Sørensen

Kruse

et al. 2016

British Journal of Surgery

199

172

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“…Sorensen et al (9) found an association with older age and male gender and the formation of a hernia in a series of 916 patients. However, other studies did not find a significant relation with gender and hernia formation (8). It is thought that accompanying disease in advanced age may affect wound healing and thus it is accepted as a risk factor for wound separation (10).…”

Section: Discussionmentioning

confidence: 99%

“…It has been reported that incarceration may occur in a rate of 15%, and strangulation in 2%, if left untreated (3,4). Recurrence rates after incisional hernia repair is approximately between 11% to 45%, taking into consideration the cost of treatment, the complications and risk of recurrence, it makes sense to evaluate factors causing its occurrence and trying to take precautions (5)(6)(7)(8).…”

Section: Introductionmentioning

confidence: 99%

A prospective evaluation of the risk factors for wound dehiscence and incisional hernia development

Yılmaz

Akıncı

Doğan

et al. 2013

UCD

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Objective: Post-laparotomy wound dehiscence, evantration and evisceration are important complications leading to an increase in both morbidity and mortality. Incisional hernias are frequently observed following abdominal surgeries and their occurrence is related to various local and systemic factors. This study aims to analyze the factors affecting wound healing by investigating the parameters that may cause wound dehiscence, incisional hernia, sinus formation and chronic incisional pain. Material and Methods:The records of 265 patients who underwent major abdominal surgery were analyzed. The data on patient characteristics, medication, surgical procedure type, type of suture and surgical instruments used and complications were recorded. The patients were followed up with respect to sinus formation, incisional hernia occurrence and presence of chronic incision pain. Statistical analysis was performed using SPSS 10.00 program. The groups were compared via chi-square tests. Significance was determined as p<0.05. Multi-variate analysis was done by forward logistic regression analysis.Results: 115 (43.4%) patients were female and 150 (56.6%) were male. Ninety-four (35.5%) patients were under 50 years old and 171 (64.5%) were older than 50 years. The median follow-up period was 28 months (0-48). Factors affecting wound dehiscence were found to be; creation of an ostomy (p=0.002), postoperative pulmonary problems (p=0.001) and wound infection (p=0.001). Factors leading to incisional hernia were; incision type (p=0.002), formation of an ostomy (p=0.002), postoperative bowel obstruction (p=0.027), postoperative pulmonary problems (p=0.017) and wound infection (p=0.011). Conclusion:Awareness of the factors causing wound dehiscence and incisional hernia in abdominal surgery, means of intervention to the risk factors and taking relevant measures may prevent complications. Surgical complications that occur in the postoperative period are especially related to wound healing problems.Key Words: Abdominal surgery, wound dehiscence, incisional hernia, sinus formation, chronic incisional pain INTRODUCTIONWound dehiscence after laparotomy can manifest with different presentations varying from simple skin detachment to evisceration and eventration, leading to an increase in surgical mortality and morbidity, as well as increase in length of hospital stay and loss of work force.Anterior abdominal wall incision hernia that can be seen in the long term is also one of the common surgical complications. Known as postoperative hernia or incisional hernia, it is thought to result from insufficient closure of the fascia and/or poor healing. Factors causing chronic or prolonged postoperative intra-abdominal pressure increase and those affecting wound healing contribute to its development. The incidence of incisional hernias vary from 2% to 20% in different sources, and in addition to pain and impairment in quality of life it may also cause significant complications (1, 2). It has been reported that incarceration may occur in a rate of 15%, ...

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“…Mendoza Jr et al 10 howed that elderly patients had a 5-fold higher chance to experience wall dehiscence than young patients 10 . Riou et al 11 reported 31 cases of wall dehiscence among 2761 patients and compared these patients to 38 other ones who had been submitted to similar operations. Among the risk factors, they cited age older than 65 years.…”

Section: Introductionmentioning

confidence: 99%

Effects of aging on abdominal wall healing in rats

et al. 2005

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Purpose:The aim of this study was to assess abdominal wall healing in old and young adult rats. Methods: On average, young animals were 110 days old and old animals were 762 days old. A 4.0 cm median laparotomy was performed under anesthesia, followed by laparorrhaphy on two synthesis planes, i.e. peritoneum-muscle-aponeurosis and skin, using continuous 5.0 nylon sutures. The animals were evaluated on the 3 rd , 7 th , 14 th and 21 st postoperative days. The resistance of the two planes was studied separately and a histopathologic analysis was performed on sections stained with hematoxylineosin and Sirius Red. Immunohistochemical analysis was also carried out using PCNA, LCA and CD34. Results: The skin scars gained resistance in a similar manner at the initial time points, but those of young rats were more resistant on the 21 st day (p=0.0029). Total and type III collagen content was similar in the two groups and type I collagen content was higher in young animals on the 14 th day. Inflammatory cell infiltration was more marked in the skin wounds of young animals on the 3 rd day (p=0.0190). Reepithelialization was similar and angiogenesis was more intense in the skin wounds of young animals on the 14 th day (p=0.0062). The peritoneum-muscle-aponeurosis wounds gained similar resistance during the early phases, but were more resistant on the 14 th day (p=0.0005) and on the 21 st day (p=0.0023) in old rats Collagen concentration was higher in the wounds of old animals on the 3 rd day (p=0.0112) and in the wounds of young animals on the 21 st day (p=0.0348). The inflammatory reaction was more intense in the wounds of old animals on the 3 rd day (p=0.0060) and angiogenesis was more intense on the 14 th day (0.0432). Conclusion: Although there are some differences in the healing course between young and old animals, age, of itself, does not impair the healing of abdominal wall wounds in rats. Key words: Wound healing. Aging. Abdominal wall. Rats. RESUMOObjetivo: Estudar a cicatrização da parede abdominal em ratos adultos jovens e velhos. Métodos: Os ratos adultos jovens tinham em média 110 dias de idade e os velhos 762 dias. Uma laparotomia mediana de 4,0 cm foi feita sob anestesia, seguida de laparorrafia com 2 planos de síntese, isto é, peritônio-músculo-aponevrose e pele, com síntese contínua de fio de náilon 5.0. Os animais foram avaliados com 3, 7, 14 e 21 dias de pós-operatório. A resistência dos dois planos foi avaliada separadamente e a análise histológica feita em cortes preparados pela Hematoxilina-eosina e Sirius red. Análise imunohistoquímica foi realizada empregando PCNA, LCA and CD34. Resultados: A cicatriz da pele ganhou resistência de modo similar nos tempos iniciais, mas as dos animais jovens foram mais resistentes no 21º dia (p=0.0029). A densidade de colágeno total e tipo III foi similar nos dois grupos, porém o colágeno tipo I mostrou-se mais denso nas cicatrizes dos animais jovens no 14.º dia. O infiltrado de células inflamatórias foi maior nas cicatrizes dos animais jovens no 3.º dia (p=...

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Factors influencing wound dehiscence

Cited by 254 publications

References 19 publications

Meta-analysis of negative-pressure wound therapy for closed surgical incisions

Meta-analysis of negative-pressure wound therapy for closed surgical incisions

A prospective evaluation of the risk factors for wound dehiscence and incisional hernia development

Effects of aging on abdominal wall healing in rats

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