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

Introduction: Surgical wound dehiscence is defined as the separation of “previously approximated wound edges due to a failure of proper wound healing,“ and is estimated to occur in up to 9% of surgical procedures.1,2 Depending upon the severity, 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. Unfortunately, many of these medical tourist clinics and centers, while often located in desirable destinations, are unprepared to manage postoperative complications which most commonly include infection and incisional dehiscence. 3,4   A recently developed bioactive glass wound matrix* (BGWM) has demonstrated promise in wound healing.5,6 Here we present successful outpatient management of surgical site infection and incisional dehiscence following a medical tourism abdominoplasty using BGWM. Use of BGWM enabled the patient to recover at home and avoid the need for hospitalization or surgical closure.  Methods:A 40 year old female presented to the office after traveling out of state for a “mommy-makeover,” including bilateral breast augmentation-mastopexy, and abdominoplasty. On postoperative day 3 she traveled back home and began to develop redness, drainage, and separation of all of her incisions. She presented to the emergency room where she was diagnosed with a surgical site infection and global dehiscence of all incisions. She had full thickness necrosis of her umbilicus, which was debrided and BGWM treatment was initiated. The BGWM was placed in direct contact with the wound surface.  A non-adherent dressing was used to secure the BGWM to the wound bed and covered with a bolster dressing to absorb exudate. Dressings were changed once per week.Results:The patient’s breast incisions were completely healed after just 1 application of BGWM, and her abdominal incisions, including the full-thickness umbilical defect, were healed after three applications. 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.IDiscussion: ncisional 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.References:1. Rosen RD, Manna B. Wound Dehiscence. Stat Pearls, [Internet]. StatPearls Publishing; Treasure Island (FL): May 1 2023. 2. Sandy-Hodgetts K, Carville K, Leslie GD. Determining risk factors for surgical wound dehiscence: a literature review. Int Wound J. 2015 Jun;12(3):265-75. 3. Zhitny VP, Kftekhar N, Caravella P, et al. Abdominal flap necrosis and wound dehiscence following a medical tourist tummy tuck. Case Rep Surg. 2020 Nov 24:2020:8819102 4. McAuliffe PB, Muss TEL, Desai AA, et al. Complications of Aesthetic Surgical Tourism Treated in the USA: A Systematic Review. Aesthetic Plast Surg. 2023 Feb;47(1):455-464. 5. Armstrong DG, Orgill DP, Galiano RD, et al. A multi-centre, single-blinded randomised controlled clinical trial evaluating the effect of resorbable glass fibre matrix in the treatment of diabetic foot ulcers. Int Wound J. 2022 May;19(4):791-801. 6. Jung S, Day T, Boone T, et al. Anti-biofilm activity of two novel, borate based, bioactive glass wound dressings. Biomed. Glasses 2019; 5:67–75. 7. Jung S, Schultz G. et al. Antimicrobial effects of borate based bioactive glass wound matrix on wound-relevant pathogens; J Wound Care 2023; 32(12) 763.