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The burst abdomen management has advanced significantly. Here we present a management of a burst abdomen of morbid obese patient with combination of modality including Bogota bag, vacuum assisted closure and tension suturing. The patient underwent laparotomy for removal of sigmoid tumor with local infiltration and had wound dehiscence associated with infection, tissue oedema and necrosis. As patient was morbidly obese and had large wound gap, we decided to manage it with Bogota bag principal and Vacuum Assisted Closing. After successful formation of granulation tissue, we were able to apply tension sutures. Hence using combination of above-mentioned options, the patient was successfully sent back to his normal routines without any complication.

Objective: To compare resource utilization of NPWT and CWT for SAWHI after surgery Summary of Background Data: NPWT is widely used in the management of complex wounds but high-level evidence of its resource use remains sparse. Methods: The multicenter, multinational, randomized clinical SAWHI study enrolled a total of 539 consecutive, compliant adult patients with SAWHI after surgery without fascial dehiscence between August 2, 2011, and January 31, 2018. Patients were randomly assigned to NPWT and CWT stratified by study site and wound size using a centralized web-based tool. Evaluation of direct resource use comprised inpatient and outpatient time, personnel and material for wound treatment, and associated wound-related procedures. The resource use analysis was primarily based on the per protocol population (NPWT 157; CWT 174). Results: Although treatment length within 42 days was significantly shorter in the NPWT arm {Mean [Standard deviation (SD)] NPWT 22.8 (13.4); CWT 30.6 (13.3); P < 0.001 U-test}, hospitalization time was shorter with CWT [Mean (SD) NPWT 13.9 (11.1); CWT 11.8 (10.8); P = 0.047 U-test]. Significantly more study participants were outpatient with CWT [N=167 (96.0%)] than with NPWT [N = 140 (89.2%) (P = 0.017)]. Time for dressing changes per study participant [Mean (SD) (min) NPWT N = 133, 196 (221.1); CWT N = 152, 278 (208.2); P < .001 U-test] and for wound-related procedures [Mean (SD) (min) NPWT 167 (195); CWT 266 (313); P < 0.001 U-test] was significantly lower with NPWT. Conclusions: NPWT reduces resource use and maybe an efficient treatment alternative to CWT for SAWHI after surgery.

Laparoscopic transhiatal approach to esophagectomy with mediastinal lymphadenectomy usually involves hand-assisted laparoscopic surgery. However, a totally laparoscopic approach can decrease the size of the abdominal wound and curtail the impact on respiration. We present a novel, totally laparoscopic transhiatal technique that may reduce respiratory complications following thoracoscopic esophagectomy. We performed a series of combined, thoracoscopic and laparoscopic, McKeown esophagectomies via a neck-abdominal first approach. Middle and lower mediastinal lymphadenectomy, subtracheal lymph node removal, and esophageal mobilization were performed via a totally laparoscopic transhiatal approach. Subsequently, upper mediastinal lymph nodes were dissected using a thoracoscopic approach. Finally, an esophagogastric anastomosis was constructed in the neck. For the 36 patients in this series, the median values of the total operative duration and the thoracoscopic portion were 499 minutes (range, 315 to 678 min) and 106 minutes (range, 67 to 243 min), respectively. Postoperative pneumonia occurred in 3 (8.3%) patients. Totally laparoscopic transhiatal approach is feasible for esophageal surgery with acceptable short-term outcomes.

Vascular Ehlers-Danlos syndrome (EDSv) can present with life-threatening surgical complications. The article describes the case of a patient with EDSv who developed total abdominal wound dehiscence and multiple enterocutaneous fistulas. Treatment with IV allogeneic mesenchymal stromal cells (MSCs) and high-dose vitamin C was trialed with success. Near-complete wound healing of the abdominal dehiscence with a 94% reduction in the size of the wound bed occurred. Maturation of the enterocutaneous fistulas also ensued.There is no current consensus on the management of large cutaneous wounds in EDSv. This article discusses the pathophysiology of wound healing with regard to nutrition requirements and growth factors with special reference to collagen deficits in EDSv. A potential therapy with IV vitamin C supplementation and MSCs is proposed following the patient's positive outcome. Medium-dose MSCs and high-dose IV vitamin C may offer significant benefits to complex and problematic wounds.

Objective: To evaluate the postoperative abdominal wound problem after hysterectomy with scalpel versus electrocautery for skin and subcutaneous dissection. Material and Methods: A total of 516 post-menopausal women having age 40 to 65 years who were planned for elective hysterectomy were included in this study. Patients having only benign disorders were included. In group E (N=258); Skin incision and tissue dissection was done using electrocautery by setting the electrocautery machine at cutting mode at 30 to 50 watts’ power. In group S (N=258); conventional scalpel was used for skin incision. Scalpel number 23 was used for skin and subcutaneous tissue dissection. Post-operative wound complications such as seroma, hematoma, wound dehiscence and wound infections were primary study endpoints. Results: Mean age was 48.6±6.9 years in electrocautery and 49.2±6.3 years in scalpel group (p-value 0.30). Seroma formation was diagnosed in 98 (37.98%) patients in electrocautery group and in 52 (20.1%) patients in scalpel group (p-value

BACKGROUND There is currently no description of abdominal domain changes in small bowel transplantation population or consensus of criteria regarding which patients are at high risk for immediate postoperative abdominal wall complications or would benefit from abdominal wall vascularized composite allotransplantation. METHODS A retrospective chart review was performed on 14 adult patients receiving intestinal or multivisceral transplantation. Preoperative and postoperative computed tomography scans were reviewed, and multiple variables were collected regarding abdominal domain and volume and analyzed comparing postoperative changes and abdominal wall complications. RESULTS Patients after intestinal or multivisceral transplantation had a mean reduction in overall intraperitoneal volume in the immediate postoperative period from 9031 cm3 to 7846 cm3 (P = 0.314). This intraperitoneal volume was further reduced to an average of 6261 cm3 upon radiographic evaluation greater than 1 year postoperatively (P = 0.024). Patients with preexisting abdominal wound (P = 0.002), radiation, or presence of ostomy (P = 0.047) were significantly associated with postoperative abdominal wall complications. No preoperative radiographic findings had a significant association with postoperative abdominal wall complications. CONCLUSIONS Computed tomography imaging demonstrates that intestinal and multivisceral transplant patients have significant reduction in intraperitoneal volume and domain after transplantation in the acute and delayed postoperative setting. Preoperative radiographic abdominal domain was not able to predict patients with postoperative abdominal wall complications. Patients with abdominal wounds, ostomies, and preoperative radiation therapy were associated with acute postoperative abdominal complications and may be considered for need of reconstructive techniques including abdominal wall transplantation.

Introduction: Wound dehiscence is one of the serious complications of surgery that is associated with mortality and morbidity (about 45%); moreover, it increases medical costs. The present study assessed the incidence and predictors of wound dehiscence in trauma patients referred to Hazrat Rasool Akram Hospital. Methods: This cross-sectional study was conducted on all trauma patients with penetrating or non-penetrating abdominal wounds referred to Hazrat Rasool Akram Hospital within April 2017-March 2020. Patients were evaluated in two stages, three days after the surgery and one month later. The data were analyzed in SPSS software (version 19) using Fisherchr('39')s exact tests, independent t-test, Pearsonchr('39')s correlation coefficient, and chi-square test. A p-value less than 0.05 was considered statistically significant. Results: The present study included 154 patients with a mean age of 43.53±16.81(age range:16-91 years). Moreover, the majority of the cases were female (n=86; 55.8%). The wound of 20 (13%) patients did not heal. There was a significant relationship between male gender and wound dehiscence (P=0.013). The two groups did not differ in age, smoking, alcohol or opioid use, and the type of surgery. Nevertheless, wound dehiscence was significantly correlated with chemotherapy and the number of sessions. The number of hospitalization days was significantly higher in the group with wound dehiscence (P=0.001). Furthermore, wound dehiscence was closely correlated with low albumin, low hemoglobin, low hematocrit (leading to anemia), and high bilirubin (leading to jaundice). Conclusions: As evidenced by the obtained results, wound dehiscence was significantly correlated with gender, low albumin, low hemoglobin, low hematocrit, bilirubin elevation, steroid usage, and chemotherapy history

Introduction: Wound closure after midline laparotomy is an essential part of surgery to produce a healthy and a strong scar. There is an alternative interrupted method of closure as compared to conventional continuous method of closure. Many comparative studies have shown different outcomes. So, we wanted to evaluate the outcome of different techniques in our setting. Aims: To compare the outcome of Interrupted abdominal closure and continuous abdominal closure in midline laparotomy wound. Methods: This was a prospective comparative study conducted in the Department of Surgery of Nepalgunj Medical College Teaching Hospital, Kohalpur, Banke, Nepal for a duration of 1 year. A total of 60 patients were selected randomly to receive either continuous or interrupted abdominal closure in midline laparotomy wound. Wound was evaluated in terms of wound discharge, infection and wound dehiscence. Results: The mean age of the patients was 38.38 years. Most commonly, the patients presented with duodenal ulcer perforation with peritonitis. The average time taken for abdomen closure in group A (16.77 minutes) was significantly less as compared to group B (27.77 minutes). The average cost of sutures for group B (Rs 1322.97) was higher than that of sutures for group A (Rs 1118) with p value of

Background Intestinal transplantation (ITx) is performed as an isolated ITx or as a part of multivisceral transplantation for intestinal failure secondary to short gut syndrome, inflammatory bowel disease, trauma, and sequelae of chronic parenteral nutrition dependence. Wound complications after ITx are very common, and abdominal wound closure cannot be immediately achieved in half of cases. Case presentation A 25-year-old man sustained an abdominal crush injury causing complete loss of his small intestine, requiring an isolated ITx in March 2016. He lost his graft because of early exfoliative rejection in November 2016. Five months after enterectomy and the immunosuppression-free period, he underwent multivisceral retransplantation in April 2017. His post-transplant course was complicated by wound healing problems that improved with treatment of his malnutrition, quantified by increasing albumin, total protein, prealbumin, weight, body mass index, and total psoas muscle area over a period of 19 months after retransplant. Conclusion To our knowledge, this is the first case described of long-term wound follow-up after a multivisceral (re)transplantation, with corresponding nutrition information and images of the wound.

Fusion of intestines and omentum after surgery, mainly with an abdominal wound, is a frequent phenomenon, proven by a number of clinical observations during repeated operations in the same subjects. Meanwhile, the question of the reasons for such a phenomenon, despite attempts to experimentally resolve it (Snger, Dembowski, Kelterborn), remains open to this day. According to the opinion of the last mentioned authors, the main cause of adhesions in the abdominal cavity after operations is infection, the accretion of the omentum to the middle line is caused by the release of air and the local inflammatory process; further - sloughing of the epithelium and scars of the peritoneum in uncomplicated cases do not give adhesions, ligatures in the abdominal cavity for the most part also do not cause adhesions, but show a tendency to encapsulate.

Introduction. Abdominal wound dehiscence (AWD) is a complication of severe postoperative abdominal surgery, with reported death rates ranging from 10% to 45%. Significant mortality, prolonged hospitalization, increased incidence of incisional hernias and reoperations for ruptured stomachs, with costs associated with the community, emphasize the severity of these complications. The VAMC score and KIMS-14 can be used as screening in predicting surgical injury dehiscence Method.This study is a diagnostic test study to assess the sensitivity and specificity of VAMC and KIMS-14 scoring in predicting the occurrence of abdominal wound dehiscence to be performed in surgery outpatient and digestive surgery ward at the General Hospital, Dr. Mohammad Hoesin Palembang in the period March to May 2019.Results. There were 44 subjects that participated in this study. VAMC has a sensitivity value of 87.5% and specificity of 97.2 with an area under curve value of 0.958 with a cut-off of  10. KIMS 14 has a sensitivity value of 100% and a specificity of 94.4% with an area under curve value of 0.944 with a cut-off of  5.Conclusion: KIMS-14 is better in sensitivity, but VAMC is more specific to predict dehiscence licensing in patients undergoing intraabdominal surgery.Keywords: VAMC, KIMS-14, abdominal wound dehiscence, post-laparotomy, mortality, burst abdomen.

Prevention of infection at the surgical area and outbreak of wounds are the most important and at the same time challenging tasks in clinical care. This research investigates the healing effect of laparotomy wounds after the use of bio-fabricated gold nanoparticles (Au NPs) prepared utilizing Thuja occidentalis leaf extract. Ultraviolet–visible (UV–Vis) spectroscopy and X-ray diffraction (X-RD) results confirmed the successful formation of Au NPs. High-resolution Transmission Electron Microscopy (HR-TEM) images confirmed the formation of spherical shaped Au NPs comprising of 30–50 nm particle size. Dermal fibroblasts were subjected to increased concentrations of Au NPs and their effect of cytotoxicity and synthesis of collagen was evaluated. The procedure of celiotomy was conducted on rabbits where the surgical area was exposed topically with either vehicle or once/everyday with Au NPs for about 14 days. Au NPs raised the collagen production from dermal fibroblasts and improved the expression of caspase 3 by exposure to a long period. AuNPs also showed cytotoxic impact with half-maximal inhibitory concentration (IC50) of 0.16 mg/mL. Regular treatment of surgical area with AuNPs led to higher collagen deposition with reduced microbial load and enhanced healing of wounds.

This case report describes a full-thickness frostbite complication following cryolipolysis for subcutaneous fat reduction performed in a non-medical esthetic clinic. The deep and large abdominal wound (15 × 12 cm) required hospitalization and multiple surgical debridement before a two-step direct closure. Even though cryolipolysis is considered as a non-invasive and safe technique to reduce local adiposity, it could present some side-effects and complications. Health-care professionals should be aware of these risks and inform their patients about its potential sequelae.

Background: Wound dehiscence/burst abdomen is a very serious post-operative complication associated with high morbidity and mortality. The aim of this study was to highlight the risk factors for wound dehiscence and remedial measures to prevent or reduce the incidence of wound dehiscence. Subjects and Methods: This is a prospective and observational study involving all those who have developed abdomen wound dehiscence after initial surgery, an elaborative study of these cases with regard to date of admission, clinical history regarding the mode of presentation, significant risk factors, investigations, time of surgery and type of surgery postoperatively, study of diagnosis and day of diagnosis of wound dehiscence is done till the patient is discharged from the hospital. The collected data is analysed and statistics were made according to need. Results: The incidence of abdominal wound dehiscence is more common in male patients in 4th to 5th decade. Patients with peritonitis due to duodenal perforation, complicated appendicitis, pyoperitoneum and intestinal obstruction carried higher risk of abdominal wound dehiscence. Abdominal wound dehiscence was more common in patients operated in emergency. Patients with intra-abdominal infection, anaemia, hypoalbuminaemia, jaundice had higher incidence of wound dehiscence. Conclusion: Wound dehiscence can be prevented by improving nutritional status of patient, proper surgical technique, controlling infections and correcting co-morbid conditions.

Utero‑cutaneous fistula is one of the most unusual entity and up till now only a few case reports have been published. Most Utero‑cutaneous fistulas are secondary to postoperative complications following caesarean or other pelvic surgery. A 30‑year‑old woman, Para 4+0, all LSCS noticed bleeding through Pfannenstiel incision scar, following forth cesarean section. A fistulous tract was demonstrated at examination with a probe, between abdominal wound and uterus. The women underwent laparotomy with excision of the fistulous tract and repair of uterine and abdominal walls by taking all preventive measures for recurrence. She remained well postoperatively, specimen taken from fistulous tract sent for histopathology.

Background Deep inferior epigastric perforator flap (DIEP) for breast reconstruction is a widely accepted technique for breast reconstruction. Secondary benefit of this technique is abdominal contour improvement. Because of direct access, abdominal plication can be performed at the time of abdominal closure. Our goal was to investigate if this addition affected the complications. Methods A retrospective chart review was performed on all DIEP flap reconstructions performed by a single surgeon at a cancer center, from March 2011 through February 2020. Presence of abdominal plication, age, and body mass index were compared with reoperation due to abdominal wound or hernia, procedure length in minutes, and length of stay. The association between the dependent and independent variables for the unadjusted and adjusted analysis was performed using the binary logistic regression analysis. Results Three hundred fifty-eight DIEP flaps performed on 233 patients for breast reconstruction were analyzed. Flap loss was 1.7%. Abdominal plication was performed in 178 flaps (49.7%) and not performed in 180 flaps (50.3%). Thirty-nine percent were immediate; 61% were delayed. The results did not show a statistically significant association between abdominal plication and the need to reoperate (P = 0.3). Results from the adjusted analysis (age, body mass index) also did not show a significant association between the plication, need to reoperate, procedure duration, or hospital stay (P = 0.4). Conclusions Abdominal plication can improve cosmetic outcomes without increasing the duration of surgery, hospital stay, or reoperation rates due to abdominal complications. Therefore, it can be a valuable addition in DIEP flap breast reconstructions.

There are two basic types of wound dehiscence, partial or complete, depending on the extent of separation. In partial dehiscence, only the superficial layers or part of the tissue layers reopen. In complete wound dehiscence, all layers of the wound thickness are separated, revealing the underlying tissue and organs, which may protrude out of the separated wound. This can be seen in some cases of abdominal wound dehiscence. A comprehensive study of these cases with keeping in record the date of admission, presenting complaints and general condition, risk factors, bold investigations, clinical diagnosis, the need for surgery and the types of surgery, followed by wound care, course in ward and day of dehiscence. Co-morbid conditions like anaemia, hypertension, diabetes mellitus, etc. were treated where possible. Initial dose of prophylactic intravenous antibiotics were given to all patients presenting with acute abdomen before surgery in emergency as well as elective cases, and course was continued with respect to requirements of every surgery. Out of 60 cases 28 patients had Hb% more than 10g/dl and 32 patients had Hb% less than 10g/dl. In the present study amongst 60 cases 2 patients had elevated hepatic enzymes. 36 patient had hypoalbuminemia. 4 patient had hyperbiluribinemia. Average stay was 18 which increases economic burden both on hospital and patients. There were 2 deaths. Mortality was mainly due to post-operative complication like septicaemia and respiratory tract infection.

Background. The macroporous polyurethane ether foam was introduced in the medical field, as early as the 90 ties, for the Vacuum-assisted closure (V.A.C.) of a wound. We describe our experience after treating abdominal wound dehiscence in a group of elderly gynecological patients with NPWT (Negative Pressure Wound Therapy), using ether foam coated with a silver layer. We reviewed elderly patients chart data that underwent abdominal surgery complicated with wound dehiscence treated with VAC for eighteen months. In all patients, the system used was the standard GranuFoam Silver™ dressing (different extents), which was usually replaced every 48/72 h. A total of 15 consecutive female patients were included. The median age was 67.3 (58-71) years. Duration of VAC treatment was median 14.2 (11-34) days, and we saw an improvement in wound repair but also clearance of S.S.I. on the third day after applying V.A.C. Ulta™. Definitive secondary closure of the wound was obtained in all patients, as the infection�s site clearance. The abdominal VAC treatment with GranuFoam Silver™ dressing in patients with infected abdominal wound dehiscence is safe and has proper patient compliance. The latest evolution of the silver foam polyether dressing, in conjunction with NPWT therapy, offers a better antimicrobial effect and shorter healing stage.

Background: The plasmakinetic cautery is a surgical dissection instrument that combines scalpel-like cutting precision with electrocautery-like haemostasis properties, and operates at lower temperatures (40–170 °C) than conventional electrocautery (200–350 °C). The aim of this study is to evaluate the clinical benefits of using plasmakinetic cautery in abdominal free flap dissection for breast reconstruction. Methods: Forty women undergoing abdominal-based microsurgical breast reconstruction (DIEP/MS-TRAM) were randomized to plasmakinetic cautery (n=20) or conventional electrocautery (n=20) for dissection of the abdominal free flap. Total abdominal wound drainage volume/duration, operation time and complications such as seroma and haematoma were examined. Results: Age, body mass index, type of reconstruction and abdominal flap weight were similar in both groups. Mean abdominal drainage volume was (279±262) mL in conventional electrocautery group and (294±265) mL in plasmakinetic cautery group (P=0.853). Plasmakinetic cautery group mean drainage duration (4.3±2.2 days) was no difference compared to conventional diathermy group (3.8±2.0 days, P=0.501). Mean operation time in the conventional electrocautery group and plasmakinetic cautery group was 157±50 vs . 174±70 min respectively (P=0.195). There was more seroma detected in the conventional electrocautery group compared to plasmakinetic cautery group at days 7, 14 and 42 post-operation, but this was not statically significant. 2 haematomas in conventional diathermy group and 1 haematoms in the plasmakinetic cautery group required evacuation. Conclusions: This study demonstrates that there are no significant differences between the use of plasmakinetic cautery and conventional electrocautery for abdominal free flap dissection.

BACKGROUND The objective of this study was to determine by a prospective randomized clinical trial whether omission of peritoneal suture has any effect on postoperative wound pain, wound sepsis, wound dehiscence, wound hernia etc. MATERIALS AND METHODS Materials for this study consisted of 200 cases, both emergency as well as routine admitted to The Department of General Surgery, MKCG Medical College and Hospital, Berhampur during the year 2016 to 2018. Altogether 200 patients were included in this series. 100 patients were included in group A where peritoneum was included and closed in layers and 100 patients in group B where peritoneum was left unsutured. Out of 100 patients, 50 cases were routine cases and 50 cases were emergency cases in each group. A comparative study was done. RESULTS 5% of patients developed wound dehiscence, 10% of patients developed wound infection in each group. 10% developed wound hernia in group A and 5% in group B. Peritoneal suturing provides little wound strength and omission makes no differences but peritoneum closure was associated with slightly increased incidence of wound hernia. CONCLUSION The present series comprised of 200 laparotomies (100 Emergency and 100 Routine), out of which in 50 emergency laparotomies and 50 routine cases, peritoneal suturing was done and in the rest half peritoneal suturing was omitted. 5% of patients developed wound dehiscence in both groups. 10% of patients developed wound infection in each group. 10% developed wound hernia in the group where peritoneum was sutured and 5% in the group where peritoneum was left unsutured. Peritoneal suturing provides little wound strength and omission makes no difference.

Objective We incorporated a hybrid-abdominal wound simulation to teach/assess the acquisition of three essential clinical skills in the ACS/ASE Medical Student Simulation-based Surgical Skills Curriculum. Method Third year students (N = 43) attended a workshop based on the ACS/ASE surgical skills curriculum for drain care/removal, staple removal and Steri-Strip application. Following a didactic session and demonstration using a simulated patient, student skill acquisition was assessed using the ACS/ASE module rating tool. Student interest/perceived usefulness of the workshop was evaluated using Keller's Motivational Survey. Results We used median scores to identify low proficiency (n = 20; scores 17–28) and high proficiency (n = 23; scores 29–35) groups. The high proficiency group was more knowledgeable, performed better drain care, had a higher global score and was more confident than the low proficiency group. The students rated the workshop highly based on the Keller's Motivational Survey. Conclusion All students were proficient in the procedure tasks and communication skills and most felt that the course was beneficial. The ACS/ASE Medical Student Simulation-based Surgical Skills Curriculum was successfully integrated into our third year surgical clerkship.

This review aims to summarize therapeutic options for the management of complex surgical wounds of the abdomen especially in regard to emergency surgery and trauma patients. Wounds in emergency surgery and trauma patients are complex and have an elevated risk for surgical site infection and hernia. In addition, the open abdomen (OA) and damage control laparotomy (DCL) are techniques being increasingly used not just in trauma patients but in critically ill surgical patients as well. Although these techniques can be lifesaving, they can be complicated and difficult to manage especially in a patient that requires multiple takebacks and those with delayed closures requiring ongoing resuscitation. This review article discusses the management options that facilitate wound closure and reduce wound complications in an emergency surgery and trauma patient. The article aims to provide a range of options that can be used regardless of resources and surgical expertise.

An 8-year-old American Quarter Horse mare presented for acute, traumatic lacerations sustained along the ventral abdomen and hind limbs after an accident involving a manure spreader. A penetrating abdominal wound, extended through the peritoneum, was explored surgically. Peritoneal fluid drained from the abdominal wound for approximately 14 days, which was managed with absorbent bandages and a hernia belt. Wound debridement was augmented with medical maggot therapy initiated on day 11 of hospitalization. On day 37 of hospitalization, febrile episodes and a draining tract along the right lateral abdominal wall prompted ultrasonic examination, leading to the identification and retrieval of 12 sequestered costochondral fragments. The mare was discharged 69 days after presentation with a well granulated, contracting wound bed. This case report describes the management of an open, penetrating, ventral abdominal wound in a horse with a functional outcome.

Background: Primary endorectal pull-through is becoming a standard of care across the globe. This study was done to compare the outcome of patients with Hirschsprung’s disease (HD) who underwent primary endorectal pull-through with patients who were treated with a staged approach. Methods: A retrospective data review was done of all patients diagnosed with Hirschsprung’s disease (HD) at Tygerberg Children’s Hospital, a tertiary hospital in Cape Town, during an 11-year period (2007 – 2018). The patients were divided into 2 groups: the primary Endorectal pull-through (ERP) group and the staged group and the two groups were compared. Results: Eighty patients with histologically confirmed Hirschsprung’s disease (HD) were seen at our institution during the study period (2007 – 2018). Four patients did not meet the inclusion criteria and were excluded. Of the remaining seventy-six who were included, forty-six patients (60.5%) had a primary endorectal-pull through (Primary group) and thirty patients (39.5%) had staged procedures (Staged group) with a stoma before the final ERP. The peri-operative complications were subdivided into major and minor complications. Minor perioperative complications in the primary group were less (13%) compared to the staged group (33%) with a p-value of 0.017, making the difference statistically significant. Anastomotic strictures were the most common complication in both groups with abdominal wound infection being more common in the staged group. The late complications were similar in both groups with a p-value of 0.43. Constipation was the most common complication in both groups, followed by soiling. Conclusion: The two groups had a similar outcome without statistically significant differences. We can safely conclude that the primary endorectal pull-through for HD is at least as safe as the staged approach in Sub- Saharan Africa. With this technique, we avoid a stoma and the necessity for two surgical procedures with added potential complications.

espanolRESUMEN La dehiscencia de la sutura de la herida quirurgica por causas infecciosas es una de las complicaciones que aumenta los costes de la estancia hospitalaria. La terapia de presion negativa (TPN) se utiliza para la cura de heridas complejas. Objetivo: mostrar la eficacia de la TPN en una herida abdominal cavitada, mediante la descripcion de un caso clinico, tratada en el Dispositivo Transversal de Hospitalizacion a Domicilio (HAD) del Hospital Clinic de Barcelona. Metodologia: Descripcion de las caracteristicas de la herida, realizacion del plan de cuidados, tratamiento y la evolucion durante el ingreso en HAD. Resultados: Este trabajo muestra los efectos beneficiosos del dispositivo de HAD respecto al tratamiento de heridas con TPN. Conclusiones: Se muestra la necesidad de la realizacion de estudios, no solo casos clinicos, para generar evidencia cientifica de la TPN en el ambito de HAD. EnglishABSTRACT Suture dehiscence of the surgical wound due to infection is one of the complications, which make the costs of hospital stay increase. Negative pressure therapy (NPT) is used to treat complex wounds. Objective: to show the effectiveness of TPN of the cavitated abdominal wound, by describing a clinical case, treated at the Home Hospitalization Transversal Device (HH) of Barcelona Clinic Hospital. Methods: The characteristics of the wound, care plan, treatment and evolution during admission to HH are described. Results: This work shows the benefit of the HH with regarding the treatment of wounds with NPT. Conclusions: It is shown the need for studies -not only clinical casesto generate scientific evidence of NPT in the HH setting.

Objectif : rapporter les resultats de la prise en charge des plaies penetrantes de l’abdomen a l’hopital national de Niamey au Niger. Patients et methodes : il s’agissait d’une etude retrospective et descriptive sur une periode de 2 ans. L’etude a concerne tous les patients de tout âge pris en charge a l’hopital national de Niamey pour plaie penetrantes de l’abdomen. Resultats : l’etude incluait 51 patients, soit 0,88% des traumatismes. Il s’agissait de 6 femmes et 45 hommes, soit un sex ratio de 7,5. L’âge moyen des patients etait de 28 ans [±10,2]. Le delai moyen d’admission etait de 4,86 heures [±2,08]. Dans 84,32% des cas les patients etaient transportes a l’hopital dans un vehicule non medicalise. Les agressions representaient 78,44% des circonstances de survenue et la plaie abdominale s’integrait dans un contexte de polytraumatisme chez 21,53% des patients. Une evisceration etait presente chez 31,37% des patients. Le traitement etait operatoire chez 90,19% des patients avec 19,56% de laparotomie non therapeutique. L’organe le plus lese etait l’intestin grele dans 31,37% des cas suivi du colon dans 23,52% des cas. La morbidite globale etait de 33,37% dominee par les hemorragies postoperatoires dans 8,69% des cas. La mortalite etait de 13,73% avec 50,14% de deces en postoperatoire immediat par hemorragie secondaire ; 28,58% de deces par retard de l’hemostase chirurgicale et 14,28% de deces par defaut de compensation des pertes sanguines en urgence.Conclusion : les plaies de l’abdomen sont frequentes chez l’adulte jeune de sexe masculin. Elles sont souvent dues a une agression par armes blanches avec un taux eleve de deces. Objective: to report the results of the management of the penetrating abdominal wounds at the national hospital of Niamey. Patients and method: it was a retrospective and descriptive study over 2 years. The study included the patients of all ages managed for penetrating abdominal wounds at national hospital of Niamey in Niger. Results: the study includes 51 patients whether 0.88 % of trauma. They were 45 men and 6 women, with a sex ratio of 7.5. The average age was 28 [±10.2] years old. The average intake time was 4.86 [2.08] hours. In 84. 32% of cases, patients were transported to the hospital in non-medical vehicle. The assault accounted for 78.44% of the circumstances of the occurrence and the penetrating abdominal wound was integrated into a polytrauma in 21.53% of cases. An evisceration was present in 31.37 % of cases. The management was operative in 90.19% of cases with 19.56% of non-therapeutic laparotomy. The most injured organ was the small intestine in 31.37% of cases followed by the colon in 23.52% of cases. The overall morbidity was 33.37%, dominated by postoperative hemorrhages in 8.69% of cases. The mortality was 13.73% with 50.14% of immediate deaths by secondary hemorrhage, 28.58% of deaths by delay of the surgical hemostasis and 14.28% of deaths by a failure of compensation of the blood losses in emergency room. Conclusion: the penetrating abdominal wounds are common in young adult males. They are often due to a stabbing assault with a high death rate.

Abdominoplasty is a major surgical procedure met with high rates of patient satisfaction and improved self-image. While many patients are lured abroad due to discounted prices for such highly requested procedures, unfortunately, there are also associated complications. A 47-year-old woman presented due to abdominal scar dehiscence due to skin necrosis secondary to a discounted abdominoplasty in Mexico. The patient had been turned away by several local surgical centers for treatment of the necrosis. The patient underwent incision, drainage, and two debridements before her abdominal wound was eventually closed. Patient recovered well postoperatively with improved aesthetic result. With the rise of social media advertisements, more patients elect to receive plastic surgery abroad. Unfortunately, many of these practices are not accurately vetted and this can complicate the postoperative care especially upon return to the United States.

Objective: To assess the role of abdominal binder in patients with midline wound dehiscence after elective or emergency laparotomy in terms of pain, psychological satisfaction and need for reclosure. Methods: It was a comparative study done at EAST Surgical Ward of Mayo Hospital, Lahore from 1st January 2018 to 31st December 2019. One hundred and sixty-two (162) patients were included in this study with post-operative midline abdominal wound dehiscence and after informed consent by consecutive non probability sampling technique. Patients were divided into two groups by lottery method into eighty-one patients each. Group-A included patients where abdominal binder was applied and Group-B included patients without abdominal binder. In both groups pain score, psychological satisfaction and need for reclosure was assessed and compared. Results: Patients with abdominal binder shows significantly less pain (P value =0.000) and more psychological satisfaction (P value = 0.000) as compared to the patients where abdominal binder was not used. However, there was no difference in reducing the need for reclosure in patients who use abdominal binder (P value = 0.063). Conclusion: Although abdominal binder helps in reducing the pain and improving the psychological satisfaction in patients with midline abdominal wound dehiscence yet it doesn’t help in healing of wound and reclosure of the dehisced abdominal wound is needed. doi: https://doi.org/10.12669/pjms.37.4.3671 How to cite this:Ammar AS, Naqi SA, Khattak S, Noumani AR. Outcome of abdominal binder in midline abdominal wound Dehiscence in terms of pain, psychological satisfaction and need for reclosure. Pak J Med Sci. 2021;37(4):1118-1121. doi: https://doi.org/10.12669/pjms.37.4.3671 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

The enlarged number of powerful vehicles in our country led to an increased speed of travel and hence the high number of traffic accidents with severe consequences, even death. Along with polytrauma caused by occupational accidents, these types of traumas require complex and often multidisciplinary surgical therapy against the clock, which places the surgeon in front of situations that are not found in the everyday practice. Injuries involving damage to the thoracic-phreno-abdominal region fall into this specific category that we have chosen to discuss in the present work. We will further present three clinical cases of patients with thoraco-phreno-abdominal injuries produced by different mechanisms. A work-accident wound produced by an angle grinder, causing left thoracoabdominal injuries; a polytrauma caused by a road accident, with a thoraco-phreno abdominal wound produced by a piece of wood that penetrated obliquely through the right thorax, in the 5th and 6th intercostal spaces, crossed the right lower lung lobe, the diaphragm, the 7th liver segment, and stopped in the right posterior costal grid, and a polytrauma following a fall from a height, with a torn diaphragm and mesentery.

Background: Intra-abdominal infections encompass a wide range of conditions from uncomplicated appendicitis to fecal peritonitis. Little is known about the burden of complicated intra-abdominal infection (cIAIs) in children in low- and middle-income countries (LMICs). Method: This a report of recent experience and a systematic review of the burden in Nigeria. Results: Of 85 children with cIAIs, the most common primary cause was typhoid intestinal perforation (54; 63.5%) and complicated appendicitis (20; 23.5%). The complication rate after surgery was high, including surgical site infection (SSI) in 49 (57.6%), post-operative intra-abdominal abscess in 14 (16.5%), and complete abdominal wound dehiscence in 13 (15.3%). The rate of re-operation was 19 (22.4%) and 12 (14.1%) patients required re-admission for adhesion intestinal obstruction and unresolved SSI. Eight (9.4%) died from overwhelming infection. Systematic review revealed only a few publications, but these were mostly on specific causes of cIAIs and publications providing comprehensive data are lacking. Conclusion: Investment in research into cIAIs in children in LMICs is needed. Efforts need to be focused on the role of source control in reducing the high complication rate and mortality.

Summary:. Pyoderma gangrenosum (PG) is a diagnostic dilemma when it presents with a superimposed infection and previous surgery without subsequent inflammatory infection. In this setting, PG is not at the forefront of the surgeon’s mind. Furthermore, the treatment for PG, systemic steroids, may cause serious morbidity if the necrotizing infection is the actual culprit. We present an autologous breast reconstruction patient with previous uncomplicated surgery and no personal history of inflammatory disease. Important clinic clues to aid the surgeon in diagnosis include irregular violaceous undermined border, purulence limited to the skin, bilateral involvement, the involvement of the abdominal wound, sparing of the mastectomy site, and relative sparing of the nipples and umbilicus.

OBJECTIVES Primary abdominal wound closure is performed at the completion of liver transplant in most patients. However, this is not always possible in pediatric recipients. The shortage of size-matched donor organs for pediatric patients means that occasionally it is necessary to use whole livers that are larger than can be accommodated comfortably in the child's abdomen. The present report outlines our experience with temporary patch closure after pediatric liver transplant of the abdominal wall. MATERIALS AND METHODS Our team performed the first liver transplant in Turkey in 1988. Since 1988, we have performed 629 liver transplant (336 adult and 293 pediatric) procedures at our center. We evaluated data of 191 liver transplants performed in recipients who were under 10 years of age. Left lateral lobe grafts were used in 169 patients (88%), and whole grafts were used in 22 patients (12%). RESULTS Temporary closure with the Bogota bag patch was necessary in 31 transplant procedures (16.2%), 3 of which involved whole livers and 28 of which involved left lateral lobe grafts. The age range of recipients was 5 months to 10 years (median, 30 mo). The temporary abdominal closure technique was preferred in 22 patients because the abdomen could not be closed during surgery. CONCLUSIONS In pediatric patients with difficult abdominal closure after liver transplant, temporary patch closure is the treatment of choice. Our preference has been reinforced silicone sheeting, which allows minimal adhesion formation between the patch and abdominal viscera; in addition, the transparent nature of the material provides a window for inspection of the donor liver.

Background. Abdominal wound dehiscence (AWD) is the separation of different layers of an abdominal wound before complete healing has taken place. It is a major cause of postoperative morbidity and mortality in sub-Saharan Africa including Ethiopia, and little is known about its prevalence and related factors in the study area. Objectives. The aim of this study is to assess the magnitude of abdominal wound dehiscence and related factors on patients operated at St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia. Methods. A hospital-based retrospective review of the chart was carried out by using the data covering three years (September 2014–September 2017) period. Data were collected from hospital medical records of sampled patients such as operation room logbooks and individual patient medical records. The collected data were checked for consistency, coded, and entered into SPSS version 20 for data processing and analysis. Descriptive analysis was conducted, and tables and graphs and summary statistics were used to depict data. Results. A total of 41 patients developed abdominal wound dehiscence from among 4137 patients who underwent abdominal laparotomy in the hospital. Among the patients, 51.2% were in the age range of 41 and above with mean age 29.8 (SD = 1.21) and 70.7% of them were male. Abdominal wound dehiscence was more common in emergency patients (90%) and vertical incision was the most common type of incision. Over half (58.5%) of the wound dehiscence occurred within 6–10 postoperative days. The majority (95.2%) of dehisced patients underwent relaparotomy for the management of the wound dehiscence, and 48.8% of them were treated with tension suture during the second operation of abdominal closure. Four of the patients (9.7%) died after the management of the second operation. Conclusion. The current study revealed that the overall magnitude of abdominal wound dehiscence in the study area was 0.99%. Most of the dehiscence has occurred in male patients, and older age groups were highly affected than the younger ones. Emergency admission is the most common form of admission identified in the study, and this signifies appropriate preoperative preparation of patients for an optimal outcome. However, regarding the management outcome, 9.8% of patients died in our study within the institution after the second operation which is the high mortality rate.

Recently high-frequency electric knife and abdominal binder are widely used in the abdominal operation in China. Nevertheless, with the high occurrence of the abdominal wound, we think that whether both these operations could be used or not. Here, we report the case of a 40-year-old female patient where negative pressure wound therapy (NPWT) was applied to her dehisced abdominal wound as well as fat liquefaction and large skin necrosis with pleasing results. The patient with high fever was referred to our department from her earlier hospital for 6 days after cesarean delivery. During the surgery, her earlier doctor used a high-frequency electric knife for convenient-using, and after the operation, the patient immediately used an abdominal binder for good shape. However, the abdominal surgical incision was opened at postoperative day 3, with fat liquefaction releasing large fatty acids along both abdominal sides with penetration under the abdominal binder. After admitted at postoperative day 6 with aggravating wound, surgery was considered because of no reduction in the size of the wound. A series of vacuum sealing drainage (VSD) or vacuum-assisted closure (VAC) as well as others, were operated. In the admitted 25th day, the wound was completely closed. NPWT is a practical and effective therapy for the treatment of numerous refractory and intractable wounds. Therefore, we suggest that the high-frequency electric knife and an abdominal binder should be avoided using an abdominal operation. This case is the first report of the use of NPWT over a dehisced abdominal wound with fat liquefaction and large skin necrosis on a postpartum patient in China.