Comparative study of wound healing in primary versus delayed primary closure in contaminated abdominal surgery

Hellenic Journal of Surgery - Tập 88 - Trang 314-320 - 2016
Prashant Kumar Singh1, Neeraj Saxena1, Devadatta Poddar1, Rohit Kumar Gohil1, Gaurav Patel1
1Department of General & Minimally Invasive Surgery, PGIMER & Dr RML Hospital, New Delhi, India

Tóm tắt

To determine optimal wound closure strategy in contaminated abdominal surgery. Wound Infection in contaminated abdominal surgery is very common and affects morbidity and mortality of patients. There is inconclusive evidence regarding superiority of two wound closure strategy i.e., primary closure (PC) and Delayed Primary Closure (DPC) in terms of wound infection. A total of 80 patients with contaminated abdominal wounds related to hollow viscus perforation were enrolled. They were prospectively randomised to have their surgical wound managed by either primary closure or delayed primary closure on fifth post op day or later if wounds were not pristine. SSI was considered if there was pus discharge from the incision site. The primary outcome measure was the incidence of wound infection and length of hospital stay. The overall infection rate for a total 0f 80 cases was 30%. The pc group had a higher incidence of wound infection (42.5%) vs 17.5% (p- 0.027) and longer length of stay (LOS) (20.7 days vs 18.1 days. (p- 0.039) Delayed primary closure is better strategy for management of contaminated abdominal wound.it reduces the wound infection rate and length of hospital stay.

Tài liệu tham khảo

Williams RS, Wilson SE. Appendicitis. In: Howard RJ, Simons RL, editors. Surgical Infectious disease. 3rd ed. Norwalk, CT: Appleton and Lange; 1995; 1167–77 Cruse PJE, Foord R. The epidemiology of wound infection. Surg ClinNorth Am 1980; 60:27–40 Leaper DJ, van Goor H, Reilly J, et al. Surgical site infection- a European perspective of incidence and economical burden. Int Wound Journal 2004; 1:247–73 DiPiro JT, Martindale RG, Bakst A, et al. Infection in surgical patients: effects on mortality, hospitalization, and postdischarge care. Am J Health Syst Pharm 1998; 55:777–81 Grace RH, Cox SJ. Incidence of incisional hernia following dehiscence of the abdominal wound. Proc R Soc Med 1973; 66:1091–2 Haddad V, Macon WL. Abdominal wound dehiscence and evisceration: contributing factors and improved mortality. Am Surg 1980; 46:508–13 Riou J-P A, Cohen JR, Johnson H. Factors influencing wound dehiscence. Am J Surg 1992; 163:324–30 Davey PG, Nathwani D. What is the value of preventing postoperative infections? New Horizons 1998; 6:S64–71 Renvall S, Niinikoski J, Aho AJ. Wound infections in abdominal surgery. Acta Chir Scand 1980; 146:25–30 Lemieur TP, Rodriguez JL, Jacobs DM. Wound management in perforated appendicitis. Am Surg 1999; 65:439–43 Chiang RA, Chen SL, Tsai YC, Bair MJ. Comparison of primary wound closure versus open wound management in perforated appendicitis. J Formos Med Assoc 2006; 105:791–5 Garibaldi RA, Cushing D, Lerer T. Risk factors for postoperative infection. Am J Med 1991; 91:158–63 Stone HH, Hester TR. Incisional and peritoneal infection after emergency celiotomy. Ann Surg 1973; 177:669–78 Raahave D, Friis-Moller A, Bjerre-Jepsen B. The infective dose of aerobic and anaerobic bacteria in postoperative wound sepsis. Arch Surg 1986; 121:924–9 Bohnen JM, Solomkin JS, Dellinger EP. Guidelines for clinical care: antiinfective agents for intra-abdominal infection. Arch Surg 1992; 127:83–9 Tsang TM, Tam PKH, Saing H. Delayed primary wound closure using skin tapes for advanced appendicitis in children. Arch Surg 1992; 127:451–3 Pettigrew R. Delayed primary wound closure in gangrenous and perforated appendicitis. Br J Surg 1981; 68:635–8 Andersen B, Bendtsen A, Holbraad L. Wound infections after appendectomy. Acta Chir Scand 1972; 138:531–6 Meissner K, Meisner G. Primary open wound management after emergency laparotomies for conditions associated with bacterial contamination: reappraisal of a historical tradition. Am J Surg 1984; 148:613–7 Stone HH, Hester TR. Topical antibiotic and delayed primary closure in the management of contaminated surgical incisions. J Surg Res 1972; 12:70–6 Mahesh CB, Shivakumar S, Suresh BS, et al. A prospective study of surgical site infections in a teaching hospital. Journal of clinical and diagnostic research 2010; 4:3114–9 Kapadia CR, Mann JB, McGeehan D, et al. Behaviour of synthetic absorbable sutures with and without synergistic enteric infection. EurSurg Res 1983; 15:67–72 Paul ME, Wall WJ, Duff JH. Delayed primary closure in colon operations. Can J Surg 1976; 19:33–6 Verrier ED, Bossart KJ, Heer FW. Reduction of infection rates in abdominal incisions by delayed wound closure technique Am J Surg 1979; 138:22–28 Smilanich RP, Bonnet I, Kirkpatrick JP. Contaminated wound: the effect of initial management on outcome. Am J Surg 1995; 61:427–30 Scott PG et al. Experimental wound healing: increased breaking strength and collagen synthetic activity in abdominal fascial wounds healing with secondary closure of the skin. Br J Surg 1985; 72:777–9 Nathens AB, Rotstein OD. Antimicrobial therapy for intraabdominalinfection. Am J Surg 1996; 172:1–6 Centers for Disease Control. The National Infection Surveillance System: the national nosocomial infection surveillance (NNIS) report, data summary from October 1986e1996. Am J Infect Control 1996; 24:380–8 Serour F, Efrati Y, Klin B. Subcuticular skin closure as a standard approach to emergency appendectomy in children: prospective clinical trial. World J Surgery 1996; 20:38–42 Rucinski J, Fabian T, Panagopoulos G. Gangrenous and perforated appendicitis. Surgery 2000; 127:136–41 Paiboon S, Wasana K, Tanapron T. Vigorous wound irrigation followed by subcuticular skin closure in children with perforated appendicitis. J Med Assoc Thai 2010; 93:318–23 Grosfeld JL, Solit RW. Prevention of wound infection in perforated appendicitis. Ann Surg 1968; 168:891–5 Pettigrew R. Delayed primary wound closure in gangrenous and perforated appendicitis. Br J Surg 1981; 68:635–8 Stephen MC, Giovanni G, Adrian W, et al. Prospective randomized trial of two wound management strategies fordirty abdominal wounds. Ann Surg 2001; 233:409–13 Bucknall TE, Cox PJ, Ellis H. Burst abdomen and incisional hernia: a prospective study of 1129 major laparotomies. Br Med J 1982; 284:931–3 Irvin TT, Stoddard CJ, Greaney MG, et al. Abdominal wound healing: a prospective clinical study. Br Med J 1977; 2:351–2 Poulsen KB, Bremmelgaard A, Sorensen AI, et al. Estimated costs of postoperative wound infections. Epidemiol Infect 1994; 113:283–95 Bucknall TE, Cox PJ, Ellis H. Burst abdomen and incisional hernia: a prospective study of 1129 major laparotomies. Br Med J 1982; 284:931–3 Irvin TT, Stoddard CJ, Greaney MG, et al. Abdominal wound healing: a prospective clinical study. Br Med J 1977; 2:351–2 Haddad V, Macon WL. Abdominal wound dehiscence and evisceration: contributing factors and improved mortality. Am Surg 1980; 46:508–13 Shulkin DJ, Kinosian B, Glick H, et al. The economic impact of infections. Arch Surg 1993; 128:449–52 Poulsen KB, Bremmelgaard A, Sorensen AI, et al. Estimated costs of postoperative wound infections. EpidemiolInfect 1994; 113:283–95 Ruey-An Chiang*, Shan-Long Chen, Yao-Chung Tsai. Delayed primary closure versus primary closure for wound management inperforated appendic;itis: A prospective randomized controlled trial. Journal of the Chinese Medical Association 2012; 75:156–159