Murtaza Badar, Ali Khan Naser, Sharif Muhammad Ashraf, Malik Imran Bashir, Mahmood Asad
Department of General Surgery, Combined Military Hospital, Bahawal Nagar Cantt.
J Coll Physicians Surg Pak. 2010 Jan;20(1):37-41.
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.
Quasi-experimental study.
Department of General Surgery, Combined Military Hospital, Bahawal Nagar Cantonment, May 2006 to June 2008.
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.
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.
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.
采用改良的腹部正中切口关闭技术，评估复杂/高风险剖腹手术中伤口裂开和切口疝形成方面的局部伤口并发症。
准实验研究。
2006年5月至2008年6月，巴哈瓦尔讷格尔驻军联合军事医院普通外科。
纳入需要剖腹手术的复杂/高风险腹部疾病病例。采用改良的腹部正中切口关闭技术。用普理灵进行间断Smead-Jones缝合，普理灵是一种用于缝合白线的不可吸收缝合材料，同时进行包括所有层次（也用普理灵）的块状缝合，并放置引流管。对患者进行3至23个月的随访。记录术后伤口裂开和切口疝形成情况。还记录其他局部伤口并发症。
在接受该手术技术的36例患者中，20例（55.55%）患有炎症/腹腔内感染，8例（22.22%）有创伤，7例（19.44%）有肿瘤，1例（2.77%）有血管病因。仅1例（2.77%）发生部分伤口裂开，1例（2.77%）发生切口疝。12例（33.33%）出现伤口感染；4例（11.11%）在皮下可触及的缝线结处疼痛，3例（8.33%）因缝线结形成窦道。平均随访期为12.47±7.17个月。
对于广泛弥漫性腹膜炎和转移性腹部肿瘤患者，伤口关闭需要特别关注。这种改良的腹部正中切口关闭技术与伤口裂开和切口疝形成的低发生率相关。
