online ISSN 2415-3176
print ISSN 1609-6371
logoExperimental and Clinical Physiology and Biochemistry
  • 15 of 19
Up
ECPB 2015, 70(2): 100–106
https://doi.org/10.25040/ecpb2015.02.100
Assisting a doctor

Modern methods for treatment of complicated abdominal wounds (Clinical case)

OREL Yu., VERKHOLA M., TERLETSKYI I., VYKHTYUK T., SLABYI O., FETSYCH T.
Abstract

Surgical site infection (SSI) is a common complication of postoperative period, the development of which depends on the following factors: the duration of surgical intervention, intraoperative blood loss, blood transfusion, cancer, application of allotransplants, inadequate antibiotic prophylaxis and related pathologies.

In 0,4–3,5 % of patients with SSI is observed wound dehiscence, which can be total and partial. In total wound dehiscence as a consequence can be developed evisceration, the development of peritonitis, intestinal fistula formation and hernia that often requires repeated intervention operations, prolongation of hospital treatment duration. The level of mortality in this complication is up to 45%, and within latest 15 years the rate was not significantly reduced.

The article presents data concerning the clinical observation of a patient’s treatment with an SSI and wound dehiscence by the method of vacuum-assisted closure (VAC).

Patient F., 55 years old, was hospitalized with a diagnosis of recurrent retroperitoneal sarcoma (histologically – liposarcoma). From the anamnesis: 7 operational interventions for the above-mentioned disease, plastics with mesh allotransplantate of anterior abdominal wall and colostomy formation.

The surgery performed on the patient: Removal of retroperitoneal liposarcoma recurrence.

Operation: laparotomy. Mobilized and removed retroperitoneal tumour, which spread from the diaphragm to the pelvis by interfacial spaces, to the mesentery of the transverse colon, and paranephric body and paraaortically. Lower mesenteric artery was covered by tumor and therefore tied. On the 3rd day of the post-operative period, SSI characters appeared, and total wound dehiscence of horizontal and vertical branches of laparatomy wound on the 4th day. In the wound massive necrosis of subcutaneous tissue were observed in all parts of the wound and mosaic necrosis of anterior abdominal wall in the horizontal branch; evisceration was not found.

An alternative method of treatment was the use of VAC. After partial necrectomy a vacuum assisted closure with a constant negative pressure – 125mm Hg was applied. Every three days the bandages were changed, observations and phased necrectomy were conducted. VAC was held for 14 days in the hospital. From the 15th day the patient was treated as an outpatient. Since the start of VAC patient’s mobility was not limited. Fixation of the edges of the anterior abdominal wall, control over exudation, cleaning and appearance of granulation tissue, gradual deformation of the wound and approaching of the edges were achieved.

Epithelialization of vertical and main part of horizontal branch of wound was achieved after 32 days of VAC.

Vacuum-assisted closure is a modern promising method for treatment of laparotomic wound dehiscence, which allows the optimum time to achieve its depuration, stimulation of reparative processes and healing.

Increased experience in VAC applying, the expansion of its use in the treatment of wound dehiscence, determination of the optimal parameters and terms for its application, combination of VAC with traditional methods will lead to advantages in improvement of treatment outcomes, including lower rates of mortality and complications, related to immobilization of patients (eg. pulmonary embolism and pneumonia), compartment syndrome, and also will reduce duration of hospital stay and provide a satisfactory level of the patient’s comfort.

Keywords: vacuum-assisted closure, wound dehiscence, surgical site infection

Full text: PDF (Ukr) 7.25M

References
  1. 1. Anthony T, Murray B, Sum-Ping J, Lenkovsky F, Vornik V, Parker B et al. Evaluatingan evidence-based bundle for preventing surgical site infection: a randomized trial. Arch. Surg. 2011;146(3):263-269.
  2. 2. Armstrong C, Dixon J, Duffy S, Elton R, Davies G. Wound healing in obstructive jaundice. Br. J. Surg. 1984;71:267-270.
  3. 3. Astagneau P, Rioux C, Golliot F, Brеcker G. INCISO Network Study Group. Morbidity and mortality associated with surgical site infections:results from the 1997-1999 INCISO surveillance. J. Hosp. Infect. 2001;48(4):267-274.
  4. 4. British Columbia Provincial Nursing Skinand Wound Committee Guideline: Assessment and Treatment of Surgical Wounds Healingby Primary and Secondary Intentionin Adults & Children, 2011.
  5. 5. Cоl C, Soran A, Cоl M. Can postoperative abdominal wound dehiscence be predicted? Tokai J. Exp. Clin. Med. 1998;23:123-127.
  6. 6. Carlson M. Acute woun dfailure. Surg. Clin. North. Am. 1997;77:607-636.
  7. 7. Fleischer G, Rennert A, Ruhmer M. Die infizierte Bauchdecke und der Platzbauch. Chirurg. 2000;71:754-762. doi.org/10.1007/s001040051134
  8. 8. Gislason H, Grоnbech J, Sоreide O. Burst abdomen and incisional hernia after major gastrointestinal operations-comparison of three closure techniques. Eur. J. Surg. 1995;161:349-354.
  9. 9. Halasz N. Dehiscence of laparotomy wounds. Am. J. Surg. 1968;116:210-214.
  10. 10. Heller L, Levin S, Butler C. Management of abdominal wound dehiscence using vacuum assisted closure in patients with compromised healing. Am. J. Surg. 2006;191(2):165-72.
  11. 11. Horan T, Andrus M, Dudeck M. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am. J. Infect. Control. 2008;36:309-332.
  12. 12. Humar A, Ramcharan T, Denny R, Gillingham K, Payne W, Matas A. Are wound complications after a kidney transplant more common with modern immunosuppression? Transplantation. 2001;72:1920-1923.
  13. 13. Keill R, Keitzer W, Nichols W et al. Abdominal wound dehiscence. Arch.Surg. 1973;106:573-577.
  14. 14. Mаkelа J, Kiviniemi H, Juvonen T, Laitinen S. Factors influencing wound dehiscence after midline laparotomy. Am. J. Surg. 1995;170:387-390.
  15. 15. Mangram A, Horan T, Pearson M, Silver L, Jarvis W. Guideline for prevention of surgical site infection. Infect. Control. Hosp. Epidemiol. 1999;20:250-278.
  16. 16. Mannin J, Wille J, Snoeren R, van den Hof S. Impact of postdischarge surveillance on surgical site infection rates for several surgical procedures: results from the nosocomial surveillance network in the Netherlands. Infect. Control. Hosp. Epidemiol. 2006;27(8):809-816.
  17. 17. Niggebrugge A, Hansen B , Trimbos J , van de Velde C , Zwaveling A. Mechanical factors influencing the incidence of burst abdomen. Eur. J. Surg. 1995;161:655-661.
  18. 18. Pavlidis T, Galatianos I, Papaziogas B, Lazaridis C, Atmatzidis K, Makris J et al. Completed ehiscence of the abdominal woun dandin criminating factors. Eur. J. Surg. 2001;167:351-354.
  19. 19. Penninckx F, Poelmans S, Kerremans R, Beckers J. Abdominal wound dehiscencein gastroenterological surgery. Ann. Surg. 1979;189:345-352.
  20. 20. Petersson P, Montgomery A, Petersson U. Wound dehiscence: outcome comparison for suture dand mesh reconstructed patients. Hernia. 2014;18(5):681-689. doi.org/10.1007/s10029-014-1268-y
  21. 21. Poole G. Mechanical factors in abdominal wound closure: the prevention of fascial dehiscence. Surgery. 1985;97:631-640.
  22. 22. Riou J, Cohen J, Johnson H. Factors influencing wound dehiscence. Am. J.Surg. 1992;163:324-330.
  23. 23. Swaroop M, Williams M, Greene W, Sava J, Park K, Surgery D et al. Multiple laparotomies are a predictor of fascial dehiscence in the setting of severe trauma. Am.Surg. 2005;71:402-412.
  24. 24. Wahl W, Menke H, Schnutgen M et al. Die Fasciendehiscenz–Ursache und Prognose. Chirurg. 1992;63:666-671.
  25. 25. Webster C, Neumayer L, Smout R, Horn S, Daley J, Henderson W et al. National Veterans Affairs Surgical Quality Improvement Program. Prognostic models of abdominal wound dehiscence after laparotomy. J. Surg. Res. 2003;109:130-137.


Програмування - Roman.im