(CS-029) Successful Management of Incisional Dehiscence and Surgical Site Infection Following a Medical Tourist Abdominoplasty Using an Innovative Bioactive Glass Wound Matrix.

Surgical wound dehiscence is estimated to occur in up to 9% of procedures.^1,2 Surgical-site infection is often considered one of the most common precursors to this complication.²  Incisional dehiscence has a significant impact on morbidity, mortality, and healthcare costs, and management may require hospitalization and/or surgical intervention.

Medical tourism has gained significant popularity in patients seeking cosmetic surgery procedures at affordable prices. Unfortunately, many of these patients develop surgical site infection and incisional dehiscence.^3,4  These complications are troublesome for patients who travel back to their homes and no longer have access to their operating surgeon when problems arise. In these circumstances, the patient is often advised to visit the nearest Emergency Room for management, where many end up being hospitalized or scheduled for surgical intervention. 

A recently developed bioactive glass wound matrix* (BGWM) has demonstrated promise in wound healing.^5,6 This bioactive glass nanofiber has been shown to stimulate wound healing and reduce the incidence of infection through broad-spectrum activity against biofilms, bacteria, and yeasts.^5-7  Here we present successful outpatient management of surgical site infection and incisional dehiscence following a medical tourism abdominoplasty using BGWM. 

Methods:

A 40 year old female presented to the office after traveling out of state for a “mommy-makeover." After arriving home, she developed redness and separation of her incisions. She presented to the emergency room and was diagnosed with a surgical site infection and incisional dehiscence. She was prescribed gentamicin ointment and referred for follow-up. In the office, her wounds were cleansed with saline. Her necrotic umbilicus was excised and BGWM treatment was initiated. The BGWM was placed in direct contact with the wound surfaces.  A non-adherent dressing was used to secure the BGWM and covered with a bolster dressing. Dressings were changed weekly.

Results:

All incisions healed after just two weeks of treatment. In all cases, the final healed scar footprint was smaller than the wound footprint, with cosmesis that was judged by the patient to be excellent.

Discussion:

Incisional complications are common following surgical procedures. Many of these complications occur in the presence of an infection, limiting outpatient treatment options and often requiring operative intervention. In this case, BGWM was successfully used to manage a surgical site infection and incisional dehiscence in the outpatient setting, avoiding the added cost and morbidity of an additional operative procedure and resulting in wound healing and cosmetically acceptable incisional closure in just 3 weeks.