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Conservative management of major abdominal wound dehiscence in premature babies - a seven-year experience
1Department of Paediatric Surgery, Royal London Hospital, London, United Kingdom.
Insights
Conservative management of abdominal wound dehiscence in preterm neonates using intrasite gel and duoderme dressings proved effective for wound healing. This approach offers a potentially life-saving option when primary closure is not feasible, even with exposed intestines.
Area of Science:
- Neonatal surgery
- Wound healing
- Gastrointestinal surgery
Background:
- Complete abdominal wound dehiscence is a critical complication in preterm neonates.
- Primary surgical closure may be contraindicated in severely premature or septic infants.
- Non-operative management strategies are crucial for improving outcomes.
Purpose of the Study:
- To analyze the non-operative management of complete abdominal wound dehiscence in preterm neonates.
- To evaluate the efficacy of intrasite gel and occlusive duoderm dressings.
- To assess outcomes when primary closure is not possible.
Main Methods:
- Seven preterm neonates with complete abdominal dehiscence post-laparotomy were treated.
- Wounds were managed non-operatively with intrasite gel and duoderm dressings.
- Dressings were changed every 3 days or as needed.
Main Results:
- All neonates achieved wound healing without immediate surgery.
- Epithelialisation ranged from 21 to 108 days.
- Two patients developed adhesive intestinal obstruction, and two developed incisional hernias post-treatment.
Conclusions:
- Intrasite gel and duoderm dressings offer a successful conservative approach for abdominal wound dehiscence in preterm neonates.
- This method is potentially life-saving in high-risk infants.
- Potential complications include adhesive intestinal obstruction and faecal fistula, necessitating careful monitoring.
Aim:
The aim of the study was to analyse our experience of managing complete abdominal wound dehiscence in preterm neonates non operatively, when primary closure was not possible. We used intrasite gel (a carboxymethyl cellulose polymer which helps in wound debridement and healing) and occlusive duoderme dressings.
Materials And Methods:
There were seven neonates who developed abdominal dehiscence following laparotomy between January 2000 and December 2006. All had complete abdominal dehiscence with visible intestines. The defect was allowed to granulate and epithelialise by the application of intrasite gel and duoderme dressings. Dressings were changed every 3 days, or earlier, if necessary.
Results:
All babies responded well, i.e. their wounds healed without the need for immediate surgery. One patient actually had a stoma in the middle of the wound which was managed with stoma bags during the same period. The period of total epithelialisation ranged from 21 to 108 days. Two patients developed adhesive intestinal obstruction requiring surgery, at 2 and 3 months after the start of treatment. On follow-up, 2/7 patients had developed an incisional hernia.
Conclusion:
Abdominal wound dehiscence can be successfully managed conservatively with intrasite gel and duoderme dressings, even if bowel is visible. This is potentially lifesaving in severely premature and septic babies in whom primary closure is not desirable. However, some patients do develop adhesive intestinal obstruction or a faecal fistula, either as a result of their primary illness or of this treatment. We believe that this series is the first of its kind to be reported in the world literature.
