Swaroop Mamta, Williams Michael, Greene Wendy Ricketts, Sava Jack, Park Kenneth, Wang Dennis
Department of Surgery, Section of Trauma, Washington Hospital Center, Washington, DC 20010, USA.
Am Surg. 2005 May;71(5):402-5.
The purpose of this study was to determine the incidence of wound dehiscence after repeat trauma laparotomy. We performed a retrospective analysis of adult trauma patients who underwent laparotomy at an urban level 1 trauma center during the past 5 years. Patients were divided into single (SL) and multiple laparotomy (ML) groups. Demographic, clinical, and outcome data were collected. Data were analyzed using chi2, t testing, and ANOVA. Overall dehiscence rate was 0.7 per cent. Multiple laparotomy patients had damage control, staged management of their injuries, or abdominal compartment syndrome as the reason for reexploration. SL and ML patients had similar age and sex. ML patients had a higher rate of intra-abdominal abscess than SL patients (13.7% vs 1.2% P < 0.0001), but intra-abdominal abscess did not predict wound dehiscence in the ML group (P = 0.24). This was true in spite of the fact that ML patients had a significantly higher Injury Severity Score (ISS) than SL patients (21.68 vs 14.35, P < 0.0001). Interestingly, wound infection did not predict dehiscence. Patients undergoing repeat laparotomy after trauma are at increased risk for wound dehiscence. This risk appears to be associated with intraabdominal abscess and ISS, but not wound infection. Surgeons should leave the skin open in the setting of repeat trauma laparotomy, which will allow serial assessment of the integrity of the fascial closure.
本研究的目的是确定再次创伤剖腹术后伤口裂开的发生率。我们对过去5年在一家城市一级创伤中心接受剖腹手术的成年创伤患者进行了回顾性分析。患者被分为单次剖腹手术（SL）组和多次剖腹手术（ML）组。收集了人口统计学、临床和结局数据。使用卡方检验、t检验和方差分析对数据进行分析。总体裂开率为0.7%。多次剖腹手术患者因损伤控制、分期处理损伤或腹腔间隔室综合征而再次剖腹探查。SL组和ML组患者的年龄和性别相似。ML组患者腹腔内脓肿的发生率高于SL组（13.7%对1.2%，P<0.0001），但腹腔内脓肿并不能预测ML组的伤口裂开（P=0.24）。尽管ML组患者的损伤严重程度评分（ISS）明显高于SL组（21.68对14.35，P<0.0001），情况依然如此。有趣的是，伤口感染并不能预测裂开。创伤后接受再次剖腹手术的患者伤口裂开的风险增加。这种风险似乎与腹腔内脓肿和ISS有关，但与伤口感染无关。外科医生在再次创伤剖腹手术时应敞开皮肤，这将允许对筋膜缝合的完整性进行连续评估。
