A Doctor's Abdominal Knife Stab Wound, Abdominal Wall Debridement and Suture Experience
For patients with abdominal knife stab wounds, in the case of unclear indications for laparotomy, debridement and suture should be performed first, followed by close observation after surgery, and then further surgery should be decided based on changes in the condition. The need for open surgery can be reduced. , reduce the suffering of patients. The depth of the wound and whether it entered the abdominal cavity should be determined intraoperatively. The direction and depth of the wound can be probed with gloves or with the aid of a probe. If the abdomen is not entered, the abdominal wall wound can be simply debridement and sutured without laparotomy. If you get into the stomach, you can decide on an exploratory laparotomy or conservative treatment depending on your physical condition. If the symptoms of hemorrhagic shock or peritonitis, positive paracentesis, etc., should be actively exploratory laparotomy.
Abdominal stab wounds should strictly follow the conservative treatment indications:
- The general condition is good, and the vital signs are stable.
- The sharp instrument entering the abdominal cavity is shorter than 3 cm.
- Simple abdominal wall stab wound.
- Abdominal examination showed that the abdomen was soft and there was no peritonitis.
- Abdominal B-ultrasound showed no effusion in the abdominal cavity. Abdominal knife stab wound, air can enter the abdominal cavity through the wound, bleeding in the abdominal wall wound or superficial liver laceration and superficial laceration of intra-abdominal tissue can cause hemorrhage in the abdominal cavity, so there is a small amount of free gas under the diaphragm and a small amount in the abdominal cavity after trauma. blood. Or fluid accumulation, not sure this is an indication for laparotomy, at which point the abdominal wall wound can be debridement and then carefully observed.
Precautions for debridement and suture:
- It is necessary to know whether the incision can be enlarged when entering the abdominal cavity for incision exploration.
- Know the size of the abdominal wall surface incision and the peritoneal incision, and the distance between them. This is compared to the injured device and therefore infers the length of the wound into the abdominal cavity and whether abdominal organs are damaged.
- Understand the bleeding of the abdominal wall wound and whether there are many blood clots in the wound. Use it to see if there is any bleeding from the wound into the abdominal cavity.
- Thoroughly debride and suture, and suture each layer of abdominal wall layer by layer, especially the peritoneum, to prevent bleeding from the wound from entering the abdominal cavity, which brings difficulties to postoperative observation.
Treatment after debridement and suture:
- Close observation of vital signs and abdominal signs 24 hours after debridement and suturing. Pay special attention to whether the abdominal pain is aggravated, whether the scope of abdominal pain expands, whether there is abdominal distension, whether there are signs of peritonitis, and whether there is moving dullness on abdominal percussion. Abdominal fluoroscopy, imaging plain film and abdominal B-ultrasound. Perform peritoneal puncture if necessary. In recent years, many trauma centers have selectively adopted a conservative approach to the treatment of abdominal stab wounds. treat. In clinical practice, for patients with abdominal knife stabbing, simple debridement and suture are performed according to the abdominal wall wound, and close observation is made after operation. Better outcomes also reduced the negative rate for laparotomy.
Practice Suture Skills with Medarchitect Laparoscopic Soft Tissue Suture Pad:
- A laparoscopic soft tissue suture practice pad is specially designed for laparoscopic exercises and can provide basic suture exercises such as tying knots, sewing, and dissecting tissues for less experienced trainers.
- High-quality, soft silicone material forms a high simulation of the skin feel, allowing the trainer to experience real surgical tactile feedback, and effectively improve the trainer's surgical ability.
- It is non-toxic, tasteless, easy to carry. Better than practicing on hard trotters or other animal carcasses to avoid the danger of bacterial/viral transmission, it can be used in a laboratory or hospital for practice at any time.
- Made by high-quality silicone material, durable and reusable, it can tolerate tension and pull while suturing. Can be used with laparoscopic training equipment.