Severe wound traction-blisters after inadequate dressing application following laparoscopic cholecystectomy: case report of a preventable complication

Abstract

BackgroundThe inadequate application of postoperative dressings can lead to significant complications, including skin injuries, compartment syndromes, and potential limb loss. To our knowledge, the occurrence of post laparoscopic cholecystectomy related skin complications have not yet been reported in the peer-reviewed literature.Case PresentationFollowing laparoscopic cholecystectomy for symptomatic gallstone disease, a seventy eight year old healthy white male broke out in painful erythema on either side of his epigastric port site. Vesicles akin to a partial thickness burns were revealed upon removal of dressings. An unusual indentation created by the dressing, and skin traction by the dressing's adhesive edges were implicated, raising questions about technique of its application.ConclusionIncorrect application of wound dressings can disrupt skin architecture, causing painful blistering. This complication should not occur to patients, as it is theoretically 100% preventable. Avoidance of stretching adhesive dressings, and careful adherence to relevant manufacturers' instructions are recommended.

Prevalence of medical adhesive-related skin injury at peripherally inserted central catheter insertion site in oncology patients

“…The prevalence of other skin lesions was not fully appreciated. In recent years, research into MARSI has concentrated on the elderly (6), postoperative patients (7, 8) and stoma patients (9). Most studies were only concerned with skin tear (10) and irritant contact dermatitis (ICD) (11).…”

Mechanical and contact characteristics of foam materials within wound dressings: Theoretical and practical considerations in treatment

“… The potential implications of an overly stiff foam‐made dressing: (A) an indentation mark caused by a foam dressing (marked by a white arrow; reproduced from Sanusi 21 who reported this phenomenon around laparoscopic port‐site wounds); (B) the theoretical effects of the porosity and deformation levels of a foam (with the same solid polymer phase) on its stiffness. The parameters of Equation ( A8 ) were set as follows: E 0 = 100 kPa, B = 2, and the strain level ε was increased from zero (ie, no deformation) to 75% strain at 25% intervals.…”

A review of blisters caused by wound dressing components: Can they impede post-operative rehabilitation and discharge?

“…To a lesser extent, blisters have also been identified in patients undergoing gynaecological surgery (Sanusi, 2011;Ousey et al, 2011). Additionally, severe wound traction-blisters after inadequate dressing application following laparoscopic cholecystectomy have been identified (Sanusi, 2011).…”

“…For example, blisters caused by tapes that are used to retain wound dressings have been identified as the causes of postoperative complications, including wound infection and prolonged length of hospital stay (Gupta et al, 2002;Tustanowski., 2009;Ousey et al, 2011;Sanusi, 2011). Blisters at dressing margins can also increase the risk of wound infection.…”