AUCTORES
Globalize your Research
Research Article | DOI: https://doi.org/10.31579/2690-1897/091
1Consultant surgeon (MBBS, MS, FCSSL), Teaching Hospital Kuliyapitiya, Sri Lanka.
2Research Assistant (MBBS), Department of Community Medicine, Faculty of Medicine, University of Peradeniya, Sri Lanka.
3Medical Officer (MBBS), Teaching Hospital Kuliyapitiya, Sri Lanka.
*Corresponding Author: Abeysinghe AHMGB, Consultant surgeon (MBBS, MS, FCSSL), Teaching Hospital Kuliyapitiya, Sri Lanka.
Citation: Abeysinghe AHMGB, Senarathne R., Wimalasena GADNB (2021) Successful Management of Abdominal Wound Dehiscence with Bogota bag, Vacuum assisted Closure combined with Tension Sutures. J. sur cas rep and img 4(7); DOI: 10.31579/2690-1897/091
Copyright: © 2021 Abeysinghe AHMGB. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cite.
Received: 08 August 2021 | Accepted: 24 September 2021 | Published: 05 October 2021
Keywords: abdominal wound dehiscence; bogota bag; burst abdomen; vacuum assisted closure; tension suturing
The burst abdomen management has advanced significantly. Here we present a management of a burst abdomen of morbid obese patient with combination of modality including Bogota bag, vacuum assisted closure and tension suturing. The patient underwent laparotomy for removal of sigmoid tumor with local infiltration and had wound dehiscence associated with infection, tissue oedema and necrosis. As patient was morbidly obese and had large wound gap, we decided to manage it with Bogota bag principal and Vacuum Assisted Closing. After successful formation of granulation tissue, we were able to apply tension sutures. Hence using combination of above-mentioned options, the patient was successfully sent back to his normal routines without any complication.
Dehiscence is a partial or total separation of previously approximated wound edges due to failure of proper wound healing. The incidence of the event as described in international data ranging from 0.4% to 3.5 % [1, 2]. The reported mortality rate is as high as 45% [3]. This scenario usually occurs between 5th and 14th day of the postoperative period4. But it can happen at any time in the postoperative period up to 30 days. Burst abdomen is seen more commonly in males over 60 years [5].
Early identification of wound dehiscence and extent of dehiscence (partial/full thickness) is very important. In most of the patients’ disruption is warned by the appearance of serosanguinous discharge on the dressing [6]. If it happens before the 7th day it may be considered pathognomonic of dehiscence6. There are various methods of surgical intervention to address the burst abdomen which include tension suturing, mesh repair, Bogota bag and vacuum assisted closure. These methods should be tailor made to the patient.
A 62 years 93kg obese patient (Height 1.6m, BMI-36.32) was referred from medical unit with an abdominal mass. He has had altered bowel habits for two months. He also complained of mucous diarrhea and on and off altered blood mixed with stool. He has no significant weight loss and appetite was normal. The colonoscopy and contrast enhance CT abdomen and pelvis revealed a sigmoid colonic tumor. His comorbidity includes type 2 diabetes mellitus and high blood pressure. After explaining to the patient, it was planned to proceed with elective sigmoid colectomy with optimizing his medical problem.
Laparotomy was performed under general anesthesia (5/5/2021) with all aseptic precautions. His bowel was prepared with polyethylene glycol the day before the surgery. During the procedure it was noted that a sigmoid tumor was adhered to the bladder dorm and loops of small intestine. The tumor was separated from the bladder and sigmoid colectomy was done incorporating a non-separable segment of small bowel loop. Colonic and small intestine anastomosis were done. Extreme care was taken not to spill intestinal content. Following surgery, patient was admitted to the ICU and managed there for 4 days and back in general word thereafter (patients vitals were normal during the perioperative period). On the 6th postoperative day patient complained pain and mild discharge at the lower end of the abdominal wound. Other than that, he had no other constitutional symptoms. On inspection serous discharge was noted. Hence a couple of sutures were taken off. After the swab was taken for culture and for antibiotic sensitivity tests, cefuroxime and metronidazole intravenously were continued in microbiologists' opinion. On the 11th postoperative day, it was noted that there was more discharge and it was smelly. Due to the very thick fat layer (nearly 12cm) of the patient it was difficult to decide whether the patient had a full thickness burst or not. Therefore, it was decided to take the patient to the theatre and examine the patient under anesthesia. During the examination it was revealed that the lower half of the rectus sheath was fully gapped. At the lower 1/3rd of the wound bowel was coming out through the rectus whereas in the upper wound the omentum was covering the bowel. The wound edges and the facial tissue were edematous and very friable.
After necrotic wound edges and unhealthy facial tissue were debrided, it was noted that the wound gap was fairly big. Hence primary closure was not possible. In consequence we had to think of other means of temporary closure. There by applying the principles of Bogota bag theory we used a sterile urine bag to close the gap. The bag was anchored to the facial sheath with non-absorbable continuous stitch. The Intercostal tube was placed over the wound and taken out through a separate incision. It was connected to the close passive draining system. Three days later a thin layer of tissue was noted over the small bowel which was exposed at the lower end of the wound. As no more bowel loops were visible on the third day of Bogota bag (urine bag), Vacuum Assisted Closing (VAC) system was employed. On the sixth day of VAC, dressing was removed. There it was noted formation of adequate granulation tissue at the base and markedly reduced wall oedema. As a result, the wound edges were able to close without much tension. Hence the skin edges were closed with tension sutures and between tension sutures skin approximated with simple interrupted mattress sutures. Postoperatively the patient's parameters were quite normal. All the inflammatory markers were within normal range. Three days after applying the tension sutures the patient was discharged (that was 12 days after the burst abdomen). One week later the patient was reviewed in the surgical clinic and found to have no significant complaints. Interrupted sutures were removed on the 10th day after suturing. The tension sutures were removed on the 18th day of suturing.
Surgical wound dehiscence (burst abdomen) is a complication following surgery in which the management makes a clinical challenge. Full thickness abdominal dehiscence is a major catastrophe and is dreaded by all surgeons. It has been noted that the incidence is increasing globally among aging populations and people with obesity, chronic diseases, immunocompromised conditions and patients with pulmonary condition etc. The risk factors for burst abdomen include local and systemic events which lead to poor wound healing. Some of them are elderly patients; more than 60 years, diabetes patients with blood sugar more than 140 mg/dL, malnutrition (hypoproteinemia- serum protein less than 6g/dl), obesity-BMI more than 13, anaemia-less than 10g/dl of hemoglobin, intra-abdominal malignancy, wound sepsis, operating time more than 2.5hr. 5 Chronic pulmonary disease, emergency surgery are the other contributing factors. Pradeep G, et al [7] has shown in their study that malnutrition is a major risk factor. It accounts for 20.3% of burst abdomen followed by obesity 12.5%. Anemia accounted for 12.4%, wound infection 12.9%, cough and abdominal distention 9.6% and 8.5% respectively. Amin et al[8] in Pakistan has shown that a higher prevalence of burst abdomen is seen in emergency surgeries (14.8%) than elective surgeries (2.7%). Study done by Parmar et al [9] has shown that the maximum incidence of burst abdomen seen within 7 days. Due to the possible anatomical factors vertical upper abdominal wounds are more likely to burst. Disruption of segmental blood supply and denervation with vertical incision weaken the wound. On the other hand it damages the transversely running elastic fibers. Due to the seriousness it is of utmost important to prevent and manage burst abdomen in a rational manner. Key points to prevent and manage burst abdomen are,
Burst abdomen could be managed effectively once we adhere to above principles.
Primary closure is the most popular practice unless there’s no significant tissue tension. This is better in fit patients whose wound dehiscence is purely due to technical failure.[10] This method is not feasible when wound infection, bowel oedema and peritonitis is there. When primary closure is not possible open technique is the option where one must have healing wound edge by debridement of unhealthy tissue. Many techniques have been used to cover the defect temporarily or permanently. Mesh repair is one of the favorite methods where high complications such as enteric fistula has been noted. This could be minimized by placing absorbable mesh with interpose omentum [11] VAC currently is very popular where sterile sponge is placed over the defect and low continuous negative suction is applied [12]. This wound can be grafted or kept to heal with secondary intentions later. These patients will end up with incisional hernia. Bogota bag is a simple plastic bag used to cover the defect which is sutured to the wound edge facial tissue to allow free expansion of viscera preventing abdominal compartment syndrome. The bag could be changed every one to two weeks’ time [13].
Our patient possible causes for wound dehiscence are
Though it was noted that the patient was having an infection, dehiscence was apparent due to a very thick fat layer (more than 12cm). Even though the wound was more gaped and had discharged on the 7th day, it was not possible to see bowel loops. However High degree of suspicious warrant to inspect the wound under anesthesia. During the examination under anesthesia the patient had a full thickness abdominal burst at the lower end of the wound.
During the wound exploration it was found to have an unhealthy wound edge with facial tissue necrosis with significant tissue oedema. The edematous unhealthy tissue which was under tension was not able to be brought together. Hence it was decided to manage the wound with open technique (Laparostomy). Mesh repair was not possible as we had no absorbable mesh. VAC placement was discouraged due to the lower end of the wounds’ bowel not covered with any kind of tissue. Considering the necrotic edematous wound edge with morbid obesity and tissue tension it was decided to manage the patient with Bogota bag principle. There we used a sterile urine bag, which was sutured to the well debride facial edges. A 28-gage intercostal tube was placed on the wound and taken out through a separate stab so that it did not disturb the main wound. It was connected to the bag and left to drain in a passive manner. On the third day it was noted that the lower part of the wounds’ bowel was covered with a thin layer of tissue. That led us to place the VAC system. On the 6th day of VAC, the patient was taken back to theatre and the wound was uncovered. There a good granulation tissue was noted. Because of the good granulation tissue rather than going for a second VAC we had two options.
1 Let it granulate and later skin graft.
2 Have the skin closed with tension suture.
Due to the thick layer of the subcutaneous fat tissue, it was assumed that it may take a longer time to fill up the gap. Therefore, we decide to go ahead with the second option where we approximated the skin with tension suture. Patient had a good recovery and was able to discharge on the 13th day of his burst abdomen.
Burst abdomen is a serious sequel of impaired wound healing. Adherence to the proper technique and genuine effort to minimize the predisposing factors together with strict aseptic procedure play a much greater role in prevention of the event.
When the primary closure is not possible, it is better to use a combination of techniques depending on the wound stage. It helps us to send the patient back to society quite early.
Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.
Journal of Clinical Cardiology and Cardiovascular Intervention The submission and review process was adequate. However I think that the publication total value should have been enlightened in early fases. Thank you for all.
Journal of Women Health Care and Issues By the present mail, I want to say thank to you and tour colleagues for facilitating my published article. Specially thank you for the peer review process, support from the editorial office. I appreciate positively the quality of your journal.
Journal of Clinical Research and Reports I would be very delighted to submit my testimonial regarding the reviewer board and the editorial office. The reviewer board were accurate and helpful regarding any modifications for my manuscript. And the editorial office were very helpful and supportive in contacting and monitoring with any update and offering help. It was my pleasure to contribute with your promising Journal and I am looking forward for more collaboration.
We would like to thank the Journal of Thoracic Disease and Cardiothoracic Surgery because of the services they provided us for our articles. The peer-review process was done in a very excellent time manner, and the opinions of the reviewers helped us to improve our manuscript further. The editorial office had an outstanding correspondence with us and guided us in many ways. During a hard time of the pandemic that is affecting every one of us tremendously, the editorial office helped us make everything easier for publishing scientific work. Hope for a more scientific relationship with your Journal.
The peer-review process which consisted high quality queries on the paper. I did answer six reviewers’ questions and comments before the paper was accepted. The support from the editorial office is excellent.
Journal of Neuroscience and Neurological Surgery. I had the experience of publishing a research article recently. The whole process was simple from submission to publication. The reviewers made specific and valuable recommendations and corrections that improved the quality of my publication. I strongly recommend this Journal.
Dr. Katarzyna Byczkowska My testimonial covering: "The peer review process is quick and effective. The support from the editorial office is very professional and friendly. Quality of the Clinical Cardiology and Cardiovascular Interventions is scientific and publishes ground-breaking research on cardiology that is useful for other professionals in the field.
Thank you most sincerely, with regard to the support you have given in relation to the reviewing process and the processing of my article entitled "Large Cell Neuroendocrine Carcinoma of The Prostate Gland: A Review and Update" for publication in your esteemed Journal, Journal of Cancer Research and Cellular Therapeutics". The editorial team has been very supportive.
Testimony of Journal of Clinical Otorhinolaryngology: work with your Reviews has been a educational and constructive experience. The editorial office were very helpful and supportive. It was a pleasure to contribute to your Journal.
Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.
This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.
Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.
As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.
Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.
International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.
Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.
Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.
I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!
"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".
I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.
We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.
I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.
I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.
I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.
Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.
“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.
Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.
The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.
Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.
Dear Monica Gissare, - Editorial Coordinator of Nutrition and Food Processing. ¨My testimony with you is truly professional, with a positive response regarding the follow-up of the article and its review, you took into account my qualities and the importance of the topic¨.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, The review process for the article “The Handling of Anti-aggregants and Anticoagulants in the Oncologic Heart Patient Submitted to Surgery” was extremely rigorous and detailed. From the initial submission to the final acceptance, the editorial team at the “Journal of Clinical Cardiology and Cardiovascular Interventions” demonstrated a high level of professionalism and dedication. The reviewers provided constructive and detailed feedback, which was essential for improving the quality of our work. Communication was always clear and efficient, ensuring that all our questions were promptly addressed. The quality of the “Journal of Clinical Cardiology and Cardiovascular Interventions” is undeniable. It is a peer-reviewed, open-access publication dedicated exclusively to disseminating high-quality research in the field of clinical cardiology and cardiovascular interventions. The journal's impact factor is currently under evaluation, and it is indexed in reputable databases, which further reinforces its credibility and relevance in the scientific field. I highly recommend this journal to researchers looking for a reputable platform to publish their studies.
Dear Editorial Coordinator of the Journal of Nutrition and Food Processing! "I would like to thank the Journal of Nutrition and Food Processing for including and publishing my article. The peer review process was very quick, movement and precise. The Editorial Board has done an extremely conscientious job with much help, valuable comments and advices. I find the journal very valuable from a professional point of view, thank you very much for allowing me to be part of it and I would like to participate in the future!”
Dealing with The Journal of Neurology and Neurological Surgery was very smooth and comprehensive. The office staff took time to address my needs and the response from editors and the office was prompt and fair. I certainly hope to publish with this journal again.Their professionalism is apparent and more than satisfactory. Susan Weiner
My Testimonial Covering as fellowing: Lin-Show Chin. The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews.
My experience publishing in Psychology and Mental Health Care was exceptional. The peer review process was rigorous and constructive, with reviewers providing valuable insights that helped enhance the quality of our work. The editorial team was highly supportive and responsive, making the submission process smooth and efficient. The journal's commitment to high standards and academic rigor makes it a respected platform for quality research. I am grateful for the opportunity to publish in such a reputable journal.
My experience publishing in International Journal of Clinical Case Reports and Reviews was exceptional. I Come forth to Provide a Testimonial Covering the Peer Review Process and the editorial office for the Professional and Impartial Evaluation of the Manuscript.
