SKIN CLOSURE IN LAPAROTOMY; DELAYED VERSUS PRIMARY CLOSURE PERFORMED FOR GENERALIZED PERITONITIS

INTRODUCTION certain factors responsible for the burst abdomens, Generalized peritonitis is easy to diagnose, but causes which are beyond one's control. Many such factors like are legion. Up to a point identifying the precise cause is anemia, jaundice, uremia, diabetes, hypoalbuminemia, 1 chronic obstructive pulmonary disease, advanced irrelevant, because a laparotomy is mandatory . malignancy, steroid use, obesity, wound infection and Disruption of abdominal surgical wounds is one of the 6,7 common causes of early re-laparotomy. Abdominal emergency surgery have been defined . Wound wound failure is defined as failure of the incision to heal infection is the most important single factor in the 8 and to maintain a normal abdominal wall anatomy. It can development of burst abdomen and incisional hernia . be divided into acute and chronic. Wound dehiscence is The optimal technique for closing a midline incision is a an acute wound failure. It has an incidence of 2 percent mass closure with a non-absorbable or slowly 2 and an associated mortality of 25 percent . It ranges from absorbable mono-filament suture using a suture length: 9,10 superficial breakdown of skin with intact deeper wound length ration of4:1 . To highlight the importance musculo-aponeurotic layers to a complete failure of and precisely learn this idea, we started a quasi3 wound and an exposure of viscera i.e. burst abdomen . experimental study in September 2006 according to a Closure of abdominal wounds passes through various protocol. In March 2007 after six months we had stages of closure in layers to single layer closure. There completed the first phase of the study. This study had is evidence that in many cases, wound failure after helped us to define the better management policy for 4 dirty abdominal wounds and we had come up with better abdominal wall closure is dependent on the surgeon . solution of the problem. This will certainly reduce the Lord Monihyne rightly said "never judge a surgeon 5 incidence of major wound infection leading to abdominal unless you see how he closes abdomen" . There are SKIN CLOSURE IN LAPAROTOMY; DELAYED VERSUS PRIMARY CLOSURE PERFORMED FOR GENERALIZED PERITONITIS