Conservative management of major abdominal wound dehiscence in premature babies - a seven-year experience.

摘要

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.