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Scar revision for persistent pain and activity limitation after exploratory laparotomy in infancy: A case series
Shruthi Srinivas1, Katherine C Bergus1, Ethan A Mezoff2
1Abigail Wexner Research Institute and Department of Pediatric Surgery, Nationwide Children's Hospital Center for Surgical Outcomes Research Columbus Ohio USA.
Insights
Neonatal transverse laparotomy incisions can lead to painful scar contractures. Surgical revision is often needed for these late complications, highlighting the importance of proper wound closure techniques.
Area of Science:
- Pediatric Surgery
- Neonatal Care
- Wound Healing
Background:
- Transverse laparotomy is the standard exploratory incision in neonates.
- This surgical approach can result in poor cosmetic outcomes and scar contractures.
- Scar contractures may lead to chronic pain and functional limitations in pediatric patients.
Purpose of the Study:
- To describe the phenomenon of late scar contractures following neonatal laparotomy.
- To highlight the necessity of surgical intervention for managing these complications.
- To raise awareness among healthcare providers regarding potential long-term issues.
Main Methods:
- Case series review of three neonates experiencing scar contractures post-laparotomy.
- Documentation of clinical presentation, including pain and physical activity limitations.
- Description of surgical revision techniques, including skin flap creation and hernia repair.
Main Results:
- All three patients presented with significant scar contractures requiring surgical revision.
- Surgical management involved complex procedures to address the abdominal wall defects.
- Subcutaneous tissue reapproximation was a key component in the revision process.
Conclusions:
- Late scar contractures are a potential complication of neonatal transverse laparotomy.
- Surgical revision is often necessary to alleviate pain and restore function.
- Recommend subcutaneous tissue reapproximation during initial abdominal wall closure to prevent such complications.
Abstract:
Exploratory laparotomy in neonates is typically performed via a transverse laparotomy incision. However, this incision may be complicated by poor cosmesis and scar contracture. In three patients, primary gastroenterologists identified significant scar contractures that resulted in pain and limitations with physical activity, necessitating surgical referrals. All patients required subsequent surgical revision of their scar, which involved creation of skin flaps, repair of abdominal wall hernias if present, and reapproximation of the subcutaneous tissue. We describe this phenomenon and the resultant need for surgical management to raise awareness of these late complications and suggest subcutaneous tissue reapproximation should be performed when possible during abdominal wall closure.
