Ram Praveen, P (2019) Prospective Study of Effect of Prophylactic Retention Sutures in Midline Laparotomy in High Risk Patients for Prevention of Wound Dehiscence in Government Rajaji Hospital, Madurai. Masters thesis, Madurai Medical College, Madurai.
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Abstract
BACKGROUND: WOUND DEHISCENCE is a devastating incident that can cause pain, mental distress, infectious complications, and financial burdens for the patient, as well as complications including evisceration and reoperation. Retention sutures have already been shown to reduce the rate of wound dehiscence after surgery, and their use has also been suggested as a treatment choice for managing fascial dehiscence, however, due to the subsequent pain, postoperative discomfort, and skin maceration, routine application of this technique has not been well accepted. Considering the controversies involved in using this method for the prevention of abdominal wound dehiscence, my study included only patients at a high risk for developing wound dehiscence who would benefit the most from prophylactic retention sutures. AIM AND OBJECTIVES: Abdominal wound dehiscence (WOUND DEHISCENCE) is a postoperative complication with high mortality and morbidity rates. Retention sutures are often used in surgical take-back for dehiscence. The aim of this study was to assess the reduced rate of dehiscence in midline laparotomy using prophylactic retention sutures in high-risk patients. MATERIALS AND METHODS: 100 patients undergoing midline laparotomy within the inclusion criteria in General Surgery Department of Govt Rajaji Hospital for a period of 1 year. This patients was followed for 2 week period and were divided into two categories and followed up and findings were collected. A central randomization was performed. The randomization sequence was based on a computer-generated list. wound dehiscence wound infection, pain on POD 1 POD3, POD 5, POD 7 were assessed.results were analysed using chi square test and paired t test. RESULTS: It has been found that as age increases wound dehiscence increases. My study shows slightly increased incidence of wound dehiscence in female patients. Among the causes for laprotomomy perforative peritonitis was the most common cause (27.5%) followed by acute intestinal obstruction(22.5%) followed by malignancy (11.5%),among this wound dehiscence was more common in vascular diseases(2 out of 4 cases) followed by malignancy(3 out of 9 cases). Among the 37 test group patients only one patient developed post operative wound dehiscence comparing to the control group in which among the 53 patients 8 patients developed post operative wound dehiscence ,with a significant p value( <0.001). Among the 80 patients 41 patients developed wound infections which was treated appropriately, among the patients with prophylactic retention sutures 22 patients out of 37 developed wound infection in comparison with those without prophylactic sutures 21 patients out of 43 developed wound infection without a significant p value(p value 0.342). Among the patients with prophylactic retention sutures the mean pain score on day 1 was 7.08 when compared to the mean score of without prophylactic sutures being 7.21 without significant p value(p value-0.414).Mean pain score on day3 for patients with prophylactic retention sutures were 4.95 when compared to that without prophylactic retention sutures being 4.84 without significant p value(p value-0.463.But when comparing the pain score on POD 5 the mean pain score for those with prophylactic retention sutures was 3.19 compared to those without retention sutures being 2.67 with a significant p –value(p value-<0.001)Again when comparing the pain score on POD 7 the mean pain score for those with prophylactic retention sutures was 1.68 compared to those without retention sutures being 1.19 with a significant p value (p value-<0.001). CONCLUSION: In the presence of a high possibility for developing wound dehiscence due to the accompanying conditions, the benefits of retention sutures may outweigh the disadvantages and the technique should be considered.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Prophylactic Retention Sutures, Midline Laparotomy, High Risk Patients, Wound Dehiscence, Government Rajaji Hospital, Madurai. |
| Subjects: | MEDICAL > General Surgery |
| Depositing User: | Subramani R |
| Date Deposited: | 03 Sep 2019 23:26 |
| Last Modified: | 03 Sep 2019 23:26 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/11433 |
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