Wound Dehiscence and Role of Delayed Primary Closure
in Gynaecological Oncology
Anirudha Rohit Podder
G. S. Jyothi
Received: 5 March 2018 / Revised: 1 April 2018 / Accepted: 3 April 2018 / Published online: 6 April 2018
Ó Association of Gynecologic Oncologists of India 2018
Aim To study the role of delayed primary closure of the abdomen in preventing wound dehiscence in women undergoing
surgery for gynaecological malignancies.
Materials and Methods Between 01 January 2017 and 30 June 2017, 22 patients underwent laparotomy at our institute.
Primary closure of abdomen was done with a suction drain placed in subcutaneous space. Between 01 July 2017 and 31
December 2017, 23 patients underwent laparotomy and for those patients who had at least one of the following condi-
tions—diabetes mellitus, obesity (subcutaneous fat [ 2.5 cm), infective foci (e.g. tuboovarian abscess), delayed primary
closure of the abdomen was followed. The wound was closed after a week.
Results There were six cases of wound dehiscence in the ﬁrst group. The duration of hospital stay exceeded 1 month from
the day of laparotomy in all the six patients. In the second group, seven patients underwent delayed primary closure.
Closure was done after a week, with a suction drain in situ. The wound healed well in all patients. All seven patients were
discharged within 15 days of laparotomy.
Discussion Patients with malignancy can have poor healing due to a variety of reasons. It can be due to neoadjuvant
chemotherapy, previous radiotherapy, and co-morbid factors like obesity, diabetes, anaemia. Delayed primary closure
involves closure of the rectus sheath following laparotomy, but the skin is closed after the blood supply to the skin and
patient’s general condition have both been improved; this will certainly lead to better wound healing. It helps in reducing
duration of hospital stay, treatment costs, antibiotic usage and is less frustrating for the surgeon and the patient. However,
the risk of future hernia and intestinal obstruction due to post-operative adhesions remains.
Conclusion There are very little published data, about the beneﬁts of delayed primary closure, but a few studies which are
available do concur that this technique should be used more often. It should be practiced in those patients who are at high
risk of wound dehiscence, since it reduces the duration of hospital stay, use of antibiotics, and treatment costs.
Keywords Delayed primary closure Á Wound dehiscence Á Corset dressing Á Burst abdomen Á SSI
Wound dehiscence due to surgical site infection (SSI) or
otherwise is a major cause of post-operative morbidity.
This is responsible for increased duration of hospital stay
and treatment costs. It also results in increased use of
antibiotics, increased antibiotic resistance, and nosocomial
infections. Gynaecological oncology as a speciality is
particularly vulnerable since most patients require a
laparotomy through a vertical incision. Many patients are
elderly, obese, diabetic, and have poor nutritional status
and are thus at high risk of wound dehiscence and burst
abdomen—a complication which carries a high morbidity
and mortality . The risk of incisional hernia which is a
late complication is also increased if there are wound
infection and dehiscence .
Laparoscopy and robotic surgeries, by virtue of using
smaller incisions, have reduced the incidence of these
complications. However, many patients are not
& Anirudha Rohit Podder
G. S. Jyothi
Department of Obstetrics and Gynaecology, Ramaiah
Medical College, Bengaluru 560054, India
Indian Journal of Gynecologic Oncology (2018) 16:23