Determinants of Wound Dehiscence in Abdominal Surgery in Public Sector Hospital

Objective: The objective of this study was to find an association and prevalence of risk factors and wound dehiscence. Study design: Cross-sectional Study. Setting and Duration: Surgical unit IV DHQ hospital, Faisalabad. From January 2002 to June 2003. Material and Methods: Patients who under went exploratory laparotomy through vertical abdominal incisions with one or more risk factors. The main out come measures found significant were wound infection- sepsis, hypoprotinemia, diabetes mellitus, emergency surgery, steroid use and advancing age. Results: 430 patients under went laparotomy through vertical incisions during last one and half years. Complete record of all the patients was maintained on Proforma. Trained surgeons with latest recommended protocol closed their wounds by using monofilament nonabsorbable 1 gauge suture taking 1 cm bite from the edge with 1 cm interstitch interval. All risk factors were made measurable on bases of history, examination, and investigations. Patients were closely observed post operatively on day 3, 7, and 10, special attention being paid to development of wound infection or wound dehiscence. Out of 430 patients, 35 patients had acute wound failure. 32 patients had the catastrophe happening in emergency laparotomies where as only 3 cases were noted in elective laparotomies (P<0.001).In sub group of emergency laparotomies incidence was highest in cases of frank peritonitis (P<0.001). In studying risk factors in dehisced cases, 29 patients under going emergency laparotomy had intra-abdominal sepsis as compared to only one patient of the sepsis in elective laparotomy group (P < 0.001). Diabetes, steroid use, and advancing age were found as statistically significant risk factors only in cases of peritonitis and intra-abdominal sepsis. Conclusion: Wound sepsis is the single most important risk factor for wound dehiscence. All other risk factors contribute to the disaster by aggravating sepsis.