DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20171422

Factors affecting post-operative wound gaping and their outcome in obstetrical and gynecological abdominal surgeries

Ridhi Narang, Gurpreet K. Nandmer, Rekha Sapkal

Abstract


Background: Postoperative wound gaping is a very traumatic event both for patient and treating doctor as it adds economical and psychological burden to the patient and the family. This study was conducted with the aim to find out the various factors affecting postoperative wound gaping and their outcome in obstetrical and gynecological abdominal surgeries.

Methods: This Retrospective observational study was carried out in the Department of Obstetrics and Gynecology at Peoples College of medical sciences and research Centre, Bhopal, India from 1st May 2014 to 31st October 2015.

Results: A total of 1310 patients underwent major obstetrical and gynecological abdominal surgeries, out of which 29 cases developed postoperative wound gaping with the percentage being 2.2%. The rate was found to be higher among the emergency obstetric case (51.7%). Associated risk factors being anemia (72%), obesity (65%), hypoproteinemia (62%) and diabetes (52%) among gynecological surgeries and prolonged rupture of membranes (53%), emergency LSCS and previous LSCS (47%) among the obstetric cases. The common causative organism was found to be E. coli (28.5%) followed by acinetobacter and pseudomonas.

Conclusions: Anemia, obesity, hypoproteinemia, diabetes, history of previous surgeries, emergency operations are the high risk factors for wound gaping in both obstetrics and gynecology surgeries. Correction of anemia, diabetes preoperatively, high protein diet and prevention of other risk factors like avoiding prolonged labor, use potent antibiotics in cases of rupture of membrane, timely intervention, provide well equipped wards with clean environment would be rewarding for better outcome of the surgery.


Keywords


Obstetrical and abdominal surgery, Wound gaping

Full Text:

PDF

References


Gantwerker EA, Hom DB. Skin: histology and physiology of wound healing. Clin Plast Surg. 2011;19(3):441-53.

Clark JJ. Wound repair and factors influencing healing. Critic Care Nursing Quarterly. 2002;25(1):1-2.

Colp R. Disruption of abdominal wounds. Annal Surg. 1934;99(1):14-27.

Zimmerman LM, Veith I. Great ideas in the history of surgery. Norman Publishing; 1993.

Khandra HP, Vyas PH, Patel NJ, Mathew JG. Factors affecting post-operative laparotomy wound complications. Int Archiv Integra Med. 2015;2:71-5.

Malhotra R, Walia GA. Study on factors affecting post operative wound infection. Int J Com Health and Med Res. 2015;1(1):17-21.

Rahman J, Sultana N, Hasan M, Begum HA. Factors of post-operative wound infection in abdominal surgeries of obstetrics and gynaecology department. J Dhaka Nation Med College Hospital. 2012;18(1):39-42.

Matin ASMR. Wound infection in planned abdominal surgery. (Dissertation), Bangladesh College of Physicians and Surgeons, 1981.

Nisty RM, Nisty GM, Patil A. Anemia, Hemoglobin, maternal outcome, fetal outcome, iron deficiency. maternal and fetal outcome in pregnancy with severe anemia. 2014;14(3795).

Alberti KG, Thomas DJ. The management of diabetes during surgery. Br J Anaesth. 1979;51(7):693-710.

Higgins GA, Antkowiak JG, Esterkyn SH. A clinical and laboratory study of abdominal wound closure and dehiscence. Archives Surg. 1969;98(4):421-7.

Houang ET, Watson C, Howell R, Chapman M. Ampicillin combined with sulbactam or metronidazole for single-dose chemoprophylaxis in major gynaecological surgery. J Antimicro Chemoth. 1984;14(5):529-35.

Lanman TH, Ingalls TH. Vitamin C deficiency and wound healing: An experimental and clinical study. Annals Surg. 1937;105(4):616.

Sharma AS, Yadav D, Bindal J. A Study to Compare Healing in Postoperative Wounds with Occlusive Gauze Dressing and after Omitting the Dressing. JMSCR. 2015;3:5734-41.

Mclean NR, Fyfe AH, Flint EF, Irvine BH, Calvert MH. Comparison of skin closure using continuous and interrupted nylon sutures. Br J Surg. 1980;67(9):633-5.

Kore S, Vyavaharkar ME, Akolekar R, Toke A, Ambiye V. Comparison of closure of subcutaneous tissue versus non-closure in relation to wound disruption after abdominal hysterectomy in obese patients. J Postgrad Med. 2000;46(1):26.

Haddad V, Macon W. Abdominal wound dehiscence and evisceration: contributing factors and improved mortality. Am Surgeon. 1980;46(9):508-13.

Ramneesh G, Sheerin S, Surinder S, Bir S. A prospective study of predictors for post laparotomy abdominal wound dehiscence. JCDR. 2014;8(1):80.