ABDOMEN
Halsteds principles
1 Closing dead space helps prevent
seroma formation and infection
4 Complications in comparison of
different techniques of fascial closure:
Early complication:
Fascial dehiscence
Infection
Late complication:
Hernia formation
Suture sinus / Incision pain
Incisional hernia
SSI
Wound
Dehiscence
Incisional
Hernia
Wound complications
increase risk for more
complications
SSI
- 2x risk of incisional hernia1
- 6x risk of wound separation2
Wound dehiscence
- Associated with 47% incisional
hernias3
Incisional hernias
- Associated with SSIs2,3
CONTINUOUS
Advantages1,4
May be used to close irregular areas
May minimize spread of infection and
allow for removal of infected stitches
Reduced risk of wound closure failure
if there is a break in only one suture
Disadvantages1-3
Knots increase foreign body material
and risks of complications
Time consuming
Advantages1,4
Better tension distribution,
less tissue strangulation
Faster to create, shortening procedure time
Less expensive5,6,7
Less material reduces foreign body
introduction
Disadvantages2,3,4
Increased risk of wound closure failure
if there is a break2,3,4
1. Sissener T. Comp Anim 2006;11:14-19. 2. Boutros S, et al. J Trauma Injury Infect Crit Care
2000;48:495-497. 3. Seiler CM, et al. Ann Surg 2009;249:576-582. 4. Wong NL. J Dermatol Surg
Oncol 1993;19:923-931. 5. Kettle, et al. Cochrane Database Syst Rev 2012; 11:CD000947. 1
6.
Boutros, et al. J Trauma 2000;48:495-497. 7. Colombo, et al. Obstet Gynecol 1997;89:684-689.
Mass closure
Mass Closure
Previous 5 meta-analysis
1.
Weiland et al.1988
2.
3.
5.
4.
Continuous = Interrupted
Absorbable inferior to Non-absorbable
Layer by layer closure inferior to One layer
Continuous = interrupted
A burst abdomen is
considered present when intestine,
omentum or other visceras were
seen in the abdominal wound
following surgery
A postoperative complication associated
with significant morbidity and mortality
Sepsis *
Cough
Anaemia
Malnutrition
Abdominal distension
Treatment
Conservative management options (wound
dehiscence) include use of saline-soaked gauze
dressings and negative pressure wound therapy
Operative management options:
- temporary closure options (open abdomen
treatment)
- primary closure with various suture techniques
- closure with applicationof relaxing incisions
- use of synthetic (non-absorbable or absorbable) and
biological meshes
- use of tissue flaps
Ramshorst, et al. Surg Technol Int. 2010 Apr; 19: 111-9
Penjahitan ulang
1. Debridement tepi luka
2. Pembuangan materi jahitan sebelumnya
3. Benang nonabsorbable 1/0 tebal
interrupted atau slow absobable material
4. Mengambil jaringan luas dari tepi luka (>
3cm) dan termasuk semua lapisan.
5. Bisa memakai mesh dan jahitan retensi
Sekuens jahitan (1-4 dan 5-8) dan aspek final (a) setelah implantasi mesh
polipropilen. Rectal sheath anterior harus dijahit dengan pola posterior untuk
melengkapi rekonstruksi
Prosedur
dilengkapi
dengan
implantasi
mesh
polipropilene
besar di antara
rectus sheath
posterior dan
muskulurs
rektus.
Smead-Jones closure
Rock JA, Jones HW. Te Lindes. Operative Gynecology. 10th ed. Lippincott Williams and Wilkins. 2008
Despite
improved
surgical
techniques and the use of prosthetic
mesh, incisional herniation remains
a major problem for the general
surgeon
Adotey JM. Incisional hernia : A review. Nigerian J Med 2006, Vol 15, 1: 34-43
Treatment
Systemic
Hypoalbuminemia, anemia, vi C
deficiency, steroid therapy, active
infection, old age
Local
Poor hemostasis & bllod supply,
ragged wound edge,
contamination of raw wound
edges, inadequate drainage of
underrcut wounds , poor
technique making & closing
incision ,anaesthesia
Posoperative
Violent coughing & emesis, ileus,
strain at urination & passing flatus
KESIMPULAN
Belum adanya konsensus dari metode teknik
penjahitan pada repair luka terbuka.
Lebih baik mencegah terjadinya luka operasi
dengan manajemen pre, intra, dan post-op
yang optimal.
08/21/08