Predicting and Managing Wound Complications of a Low-Transverse Abdominal Incision Site: Lessons Learned from 1200 Patients

Goals/Purpose:   The low-transverse abdominal incision site is commonly managed following body contouring procedures and free flap breast reconstruction. Preventing wound complications, and optimally treating their inevitable occurrence is paramount to patient satisfaction and avoidance of long-term abdominal sequelae. The purpose of this study is two-fold: 1) stratify preoperative risk factors that predict abdominal wound complications 2) identify the efficacy and patient selection factors for postoperative treatment strategies, including reoperative delayed primary closure

Methods/Technique:   Patients were identified via a prospectively maintained database of abdominally-based free flaps performed from January 2005 – July 2012. Delayed wound healing was defined as an open surgical wound >30 days from the date of surgery.  Univariate statistical analyses included Fisher's exact test and the Mann-Whitney U test, in addition to binary logistic regression for multivariate significance.  A value of p<0.05 denoted statistical significance. 

Results/Complications: A total of 1218 abdominal donor sites were reviewed and 167 (13.7%) cases of delayed abdominal wound healing were identified. Multiple preoperative risk factors were identified as described in Table 1 and Table 2. A subgroup analysis was performed on patients with delayed healing, identifying factors associated with chronic wounds (Table 3). Eleven patients underwent reoperative delayed primary wound closure (DPWC). In comparison to those patients treated with wet to dry dressings or negative pressure wound therapy, patients whom underwent DPWC demonstrated markedly improved outcomes (Table 4).

Conclusion:   Patient selection factors are predictive of early wound complications. However, postoperative wound care treatment modalities are more predictive of chronic abdominal wounds. While this patient population is specific to free flap breast reconstruction, there remains widely applicable risk factors and evidence-based treatment measures for body contouring patients as well. Early reoperative primary closure in the office or operating room resulted in markedly lower rates of hospital readmission and revision surgery.

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