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Modified midline abdominal wound closure technique in complicated/high risk laparotomies.

OBJECTIVE
To assess the local wound complications in complicated/ high risk laparotomies in terms of wound dehiscence and incisional hernia formation with a modified technique of midline abdominal wound closure.


STUDY DESIGN
Quasi-experimental study.


PLACE AND DURATION OF STUDY
Department of General Surgery, Combined Military Hospital, Bahawal Nagar Cantonment, May 2006 to June 2008.


METHODOLOGY
Cases of complicated/high risk abdominal conditions, which required laparotomy, were included in the study. A modified midline abdominal wound closure technique was used. Interrupted Smead-Jones sutures with prolene, a non-absorbable suture material for closure of linea alba was combined with mass closure involving all the layers (also with prolene) and drains were placed. Patients were followed-up for 3-23 months. The postoperative wound dehiscence and incisional hernia formation were noted. Other local wound complications were also recorded.


RESULTS
Out of the 36 patients undergoing this surgical technique, 20 (55.55%) had inflammatory/intra-abdominal sepsis, 8 (22.22%) had trauma, 7 (19.44%) had neoplasia and 1 (2.77%) had vascular aetiology. Only 1 (2.77%) had partial wound dehiscence and 1 (2.77%) developed incisional hernia. Wound infection was noted in 12 (33.33%) cases; 4 (11.11%) experienced pain over the subcutaneous palpable knots and 3 (8.33%) developed sinus due to the knots. The average follow-up period was 12.47+7.17 months.


CONCLUSION
Patients with extensive widespread generalized peritonitis and metastatic abdominal tumours need special attention regarding wound closure. This modified technique of midline abdominal wound closure is associated with low incidence of wound dehiscence and incisional hernia formation.