6 Risk factors of poor wound healing in open abdomen patients with fistula undergoing the abdominal wall reconstruction utilizing biological mesh

Abstract Objective The management of wound in open abdomen (OA) patients with fistula presents a significant clinical challenge, this study aimed to evaluate the clinical characteristics of and identify risk factors of poor wound healing following abdominal wall reconstruction using biologic mesh. Methods The study included 86 patients, who underwent abdominal wall reconstruction by biological mesh of open abdomen with fistula at the Department of General Surgery, Jinling Hospital, from January 2010 to August 2023. Their perioperative data were retrospectively analyzed, and clinical characteristics were compared. Univariate analysis and multivariate logistic were used to screen the independent factors of poor wound healing of abdominal wall reconstruction. Results The rate of poor wound healing after abdominal wall reconstruction was 23.26% (20/86) in OA patients with fistula. Body mass index (BMI), low BMI, abdominal wall defect zoning, neutrophil counts (NEUTs) on the first preoperative day, white blood cells (WBCs) on the first postoperative day, NEUTs on the first postoperative day, WBCs on the third postoperative day, NEUTs on the third postoperative day, procalcitonin (PCT) on the seventh postoperative day, WBCs on the seventh postoperative day, NEUTs on the seventh postoperative day, length of hospitalization, total hospitalization cost, and number of blood transfusions showed statistically significant differences between the group with well wound healing and the group with poor healing (P < 0.05). Multifactorial analysis of the results showed that NEUTs on the first postoperative day (OR: 0.675, 95%c.i.: 0.457–0.998, P: 0.049), NEUTs on the third postoperative day (OR: 0.645, 95%c.i.: 0.450–0.925, P: 0.017), and PCT on the seventh postoperative day (OR: 0.134, 95%c.i. 0.024–0.746, P: 0.022) were independent risk factors for poor wound healing. Conclusions NEUTs on the first postoperative day, NEUTs on the third postoperative day, and PCT on the seventh postoperative day are independent risk factors for poor wound healing. For patients undergoing abdominal wall defect reconstruction for open abdomen combined with fistula, clinical wound management should focus on preventive measures accordingly to ensure well wound healing.