Acute wound failure, otherwise known as wound dehiscence or burst abdomen refers to postoperative separation of abdominal Musculo-aponeurotic layers. Wound dehiscence is among the most dreaded complication faced by the surgeon and is of great concern because of the risk of evisceration; the need for some form of intervention and possibility of repeat dehiscence, surgical wound infection and incisional hernia formation.

Acute wound failure occurs in approximately 1% to 3% of patients who undergo an abdominal operation. Dehiscence most often develops 7 to 10 days postoperatively but may occur any time after surgery, from 1 to more than 20 days. A multitude of factors may contribute to wound dehiscence. Acute wound failure is often related to technical errors in placing sutures too close to the edge, too far apart, or under too much tension. Local wound complications such as hematoma and infection can also predispose to localized dehiscence. In fact, a deep wound infection is one of the most common causes of localized wound separation. Increased intra-abdominal pressure (IAP) is often blamed for wound disruption and factors that adversely affect wound healing are cited as contributing to the complication. In healthy patients, the rate of wound failure is similar whether closure is accomplished with a continuous or interrupted technique. In high-risk patients, however, continuous closure is worrisome because suture breakage in one place weakens the entire closure. Prevention of acute wound failure is largely a function of careful attention to technical detail during fascial closure, such as proper spacing of the suture, adequate depth of bite of the fascia, relaxation of the patient during closure, and achieving a tension-free closure. For very high-risk patients, interrupted closure is often the wisest choice. Alternative methods of closure must be selected when primary closure is not possible without undue tension. Although retention sutures were used extensively in the past, their use is less common today, with many surgeons opting to use a synthetic mesh or bio absorbable tissue scaffold

Background and Objectives

The present study was undertaken to assess the proportion of burst abdomen in post midline laparotomy patient using interrupted sutures versus continuous suture technique in sheath closure.

Method Of Collection Of Data:  A total of 50 patients undergoing midline laparotomy after taking written and informed consent and were divided equally in to 25 cases each in the study group (interrupted) and control group (continuous suture) and were followed up in the post-operative period.

Source of Data: All patients satisfying inclusion criteria admitted in General surgery Department, GIMS GADAG for a period of 1 year

All patients undergoing emergency Laparotomy at GIMS Gadag. This is the prospective study. A written and informed consent to be obtained from the patients to be included in the study and data- complaints, General examinations, Abdominal examination, Biochemical evaluation of blood sugar, blood urea, electrolytes and other specific investigations, post op course carefully observed and criteria managed to analyse morbidity, hospital stay.

Continuous closure was performed using No.1 prolene, care being taken place each bite 1.5 to 2 cm from the linea alba edge with successive bites being placed 1 cm from each other. The edges of linea alba was gently approximated without strangulation with an attempt to keep a suture to wound length ratio 4:1.

Interrupted closure was performed using No.1 Prolene suture. A large bite was taken outside in 2cm from the cut edge of the linea alba. The needle emerged on the other side from inside out diagonally 2 cm from the edge and 4cm above and below the first bite. The strand was subsequently crossed or looped around the free end of suture and continued outside-in, diagonally at 90 „ to the first diagonal. The two-end tied just tight enough to approximate the edges of linea alba taking care not to include bowel or omentum between the edges.

This created X like crosses one on the surface and another deep to lineaalba. The next X suture was placed 1 cm away from the previous one. Henceforth in a 14 cm long, 3 X sutures were applied.

Eligibility Criteria:

Inclusion Criteria: All patients scheduled to undergo midline laparotomy for emergency reasons were included in the study

Exclusion Criteria:

1. Patients younger than 16 years
2. Patients who had undergone previous laparotomy for any conditions
3. Patients who required a re-exploration in post op course were excluded.

 ANALYSIS Data analysis was done with the help of computer using SPSS 18 software Using this software range, frequencies, percentages, means, standard deviations, chi square and 'p' values were calculated  and Chi-square test was used to test the significance of difference between quantitative variables.

Table No. 1: Demographic Profile

Table No. 2: Rectus Sheath Closure Technique In Emergency Setting

Table No. 3: Wound Dehiscence Emergency Cases

Table No. 4: Prolonged Post Op Hospital Stay Emergency Cases

Table No. 5: Normal Wound Healing

Table No. 6: INCISIONAL HERNIA EMERGENCY CASES

P value=0.013

WOUND DEHISCENCE, is a dreaded complication that leads to infectious complications, mental stress, prolonged hospital stay, sepsis, re-surgery etc. Host factors like diabetes, obesity, immune compromised status, patient, malignancy completed chemotherapy, radiotherapy, surgeon’s expertise, technique, suturing material, any factors that leads to increased intraabdominal pressure. Continous suturing of rectus sheath, in an emergency cases leads to increased rate of wound dehiscence in the post-operative period leading on to formation of incisional hernia in the future, hence such  patients needs re-surgery in the post-operative period in the hospital or may undergo for incisional hernia repair in the future. Disadvantages of continous sheath closure includes, single knots are usually placed. Hence if patients develops wound infection, or any factors that increases intraabdominal pressure leads to give away of rectus. In contrast if Interrupted X suturing is applied, three or four intermittent knots will hold the rectus that prevents the formation of wound dehiscence.

Hence study conducted in 50 patients who underwent laparotomy 25 patients in which them Interrupted X suture was applied, they were followed up in the early post-operative period and regular follow up- 3 of the patients developed wound dehiscence, in contrast with control group in which 9 patients developed burst abdomen.

1 of our patients from the study group developed incisional hernia,7 from control group developed incisional hernia.

Therefore, Interrupted X suturing technique overweighs the disadvantages of the continous suturing technique. Hence the technique should be considered

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