Wound dehiscence: is still a problem in the 21th century: a retrospective study

We retrospectively analyzed 3500 laparotomies. Age over 75 years, diagnosis of cancer, chronic obstructive pulmonary disease, malnutrition, sepsis, obesity, anemia, diabetes, use of steroids, tobacco use and previous administration of chemotherapy or radiotherapy were identified as risk factorsFifteen of these patients developed wound dehiscence. Emergency laparotomy was performed in 9 of these patients. Patients who had more than 7 risk factors died.It is important for the surgeon to know that wound healing demands oxygen consumption, normoglycemia and absence of toxic or septic factors, which reduces collagen synthesis and oxidative killing mechanisms of neutrophils. Also the type of abdominal closure may plays an important role. The tension free closure is recommended and a continuous closure is preferable. Preoperative assessment so as to identify and remove, if possible, these risk factors is essential, in order to minimize the incidence of wound dehiscence, which has a high death rate.Surgical wound dehiscence after laparotomy remains a serious complication. It presents a mechanical failure of wound healing of surgical incisions. Surgical incisions stimulate the healing process which in reality is a complex and continous process with four different stages: Hemostasis, inflammation, proliferation, and maturation [1].During hemostasis, platelets aggregate, degranulate and activate blood clotting. The clot is degrading, the capillaries dilates and fluids flow to the wound site, activating the complement cascade.Macrophages, lysis of cells and neutrophills are a source of cytokines and growth factors that are essential for normal wound healing [1,2].The proliferation phase which is the phase of granulation tissue forms in, the wound space begins in the 3 postoperative day and lasts for several weeks.The most important factor in this phase are fibroblasts which move to the wound and are responsible for the collagen synthesis [3,4]. The maturation phase begins in th