The success of laparotomy, a common procedure in obstetrics and gynecology, depends not only on the surgical operation, but also on the healing of the incision after surgery. With the development of medical technology, the incidence of poor incision healing in gynecologic laparotomy has been reduced to 5%. Poor incisional healing includes fat liquefaction, incisional infection, hematoma formation, delayed healing, and incisional dehiscence, the first three of which are the most common. Poor incision healing not only causes pain for patients, but also increases the medical burden and even affects the harmony of doctor-patient relationship. There is still controversy on how to manage and prevent poor healing of surgical incisions, and there is a lack of appropriate guidelines. This article discusses the risk factors associated with poor healing of abdominal surgical incisions in obstetrics and gynecology, treatment and prevention. I. Risk factors associated with poor surgical incision healing Poor surgical incision healing is a series of pathological processes in which the local tissue cannot be repaired by regeneration, repair, and reconstruction. According to the 2016 ACS Guidelines: Surgical Site Infections (Updated), factors associated with poor incision healing can be divided into internal and external factors. 1, Internal factors, i.e., patient’s own factors, can be divided into controllable and non-controllable factors: (1) controllable intrinsic risk factors include hyperglycemia and diabetes, dyspnea, history of smoking and alcohol consumption, preoperative albumin <3.5 mg/dL, total bilirubin >1.0 mg/dL, obesity, and immunosuppression; (2) non-controllable intrinsic factors include advanced age, history of recent radiation therapy, and history of skin and soft tissue infections. 2. External factors include surgery, facilities, and preoperative and postoperative management: (1) Surgery-related risk factors include: emergency surgery, complex surgery, and complex incisions. (2) Facility-related risk factors include: inadequate ventilation, operating room congestion, and poor facility sterilization. (3) Preoperative management-related risk factors include: preoperative infection, inadequate skin preparation, selection, dosage, and duration of antibiotics. (4) Intraoperative risk factors include: length of surgery, blood transfusion, aseptic principles, failure to strictly enforce the principles of hand brushing and gloving, hypothermia, and poor glycemic control. Second, the treatment of poor healing of surgical incision 1, fat liquefaction Fat liquefaction refers to the process of aseptic degenerative necrosis of fat cells at the surgical incision site, and the overflow and aggregation of fat droplets after the rupture of fat cells, accompanied by local sterile inflammatory reaction. It mostly appears 3-7 days after surgery. There is no uniform standard for its diagnosis, and clinicians mostly judge it by experience. The treatment of fat liquefaction includes surgery and conservative treatment. Surgical treatment involves incision along the original incision, complete removal of liquefied fatty tissue and placement of drainage tubes for adequate drainage. Conservative treatment is varied. For small-scale fat liquefaction, 1 or 2 stitches of sutures can be removed, and hypertonic saline or hypertonic sugar gauze strips can be used for drainage after dilation, and the medication can be changed daily; some people propose sterile white sugar to fill the incision slightly above the skin, covered with sterile gauze and fixed with butterfly tape, and the medication can be changed every 2-3 days. Chinese herbal treatment recommends a mixture of rhubarb and mannitol applied externally (5 mm above the incision edge, fixed with a lap band, and changed every 1-2 days) to the surgical incision, which, when combined with infrared physical therapy, can significantly shorten the healing time of the incision, reduce the number of dressing changes, and reduce the risk of secondary debridement and suturing compared with the common method of dressing changes and squeezing and draining. Wet therapy accelerates epithelialization, promotes fibroblast proliferation and enhances their viability. In addition, laser irradiation can inhibit bacterial activity and reduce inflammation; promote collagen growth, fibroblast proliferation, and neovascularization, thereby accelerating wound healing. All of these methods can promote incisional healing to varying degrees, but there is a lack of large-scale comparative clinical studies on the advantages and disadvantages of their combined use. Most patients with poorly healed incisions can heal with conservative treatment, but a small number of patients with prolonged infection need to be alerted. 2. Incisional infection Neglecting the principle of asepsis in any part of the surgical procedure may cause surgical incisional infection. Abdominal incision infection usually appears 5 to 7 days after surgery. In general, if symptoms such as increased pain at the incision, increased body temperature and accelerated pulse occur 2~3 days after surgery, the possibility of incision infection should be alerted; if there is fluid exudation from the incision, along with redness, swelling, hard lumps and obvious pain, the diagnosis of incision infection can be made; if there is purulent discharge from the incision, the incision infection is extremely serious. The key to the management of incisional infection is early detection and early treatment. If incisional infection is suspected, antibiotics can be used prophylactically and reasonably. If there is redness and swelling around the incision, hard nodules or unexplained persistent fever and painful incision, increase the number of dressing changes, squeeze the incision with daily dressing changes, apply wet compresses with iodophor, and use antibiotics reasonably. If the diagnosis is incisional infection, bacterial culture of secretion and drug sensitivity test should be performed, antibiotics should be reasonably applied, daily dressing change, and conservative treatment can be given for plasma exudate; septic infection should be immediately removed partially or completely with sutures removed, all layers of involved tissues thoroughly opened, and secondary sutures or butterfly tape stretched at a later date until the incision is healed; when there is local fluctuation or rupture, incision and drainage should be promptly cleared, pus cavity opened, necrotic tissues cleared, and pus cavity removed using The incision should be flushed with physiological saline or hydrogen peroxide, wet dressing with saline gauze, and daily dressing change until the granulation tissue grows to cover the incision surface to close the incision, or butterfly tape can be used to pull the incision. Prevention of poor healing of surgical incisions The 2016 ACS Guidelines: Surgical Site Infection (updated version) proposes preventive measures mainly including preoperative, intraoperative and postoperative interventions. 1. preoperative interventions Preoperative bathing with chlorhexidine can reduce the accumulation of pathogenic bacteria on the skin surface, although it does not reduce the risk of surgical site infection. Smoking cessation 4-6 weeks prior to surgery reduces the risk of surgical site infection, and expert consensus recommends discontinuing the use of marijuana and e-cigarettes. All diabetic patients should control blood glucose at 6.11-8.33 mmol/L levels. If hair removal is required, barber scissors are preferable to razors; all skin preparations should be done with alcohol-containing liquids, or chlorhexidine if alcohol cannot be used. 2. Intraoperative intervention Prophylactic antibiotics are administered 1 hour before the surgical incision is made, and vancomycin and fluoroquinolone are used within 2 hours; antibiotics are administered again to maintain adequate tissue drug concentrations according to the drug half-life or blood loss of 1500 ml; antibiotics are discontinued before the incision is closed. Intraoperative maintenance of body temperature can reduce the risk of surgical site infection. 3. Postoperative intervention Early bathing (12 hours postoperatively) was not associated with surgical site infection. There is no evidence of a relationship between dressing removal time and surgical site infection. Topical mupirocin is superior to regular dressing changes.