Abstract
Reported wound infection rates are high after primary closure of contaminated wounds high. When wound infection develops, reopening of the wound and frequent changes of dressings with irrigation are required. For contaminated abdominal wounds after previous closure of the musculo-aponeurotic layer with PDS, the wounds are typically left open with loose, fine-mesh gauze inserted between the skin and subcutaneous margins down to the level of fascial closure. The wounds are managed with wet-to-dry dressings changed twice daily until postoperative days 5 to 7, when a clinical judgement is made as to whether to proceed with delayed primary closure (DPC) or to allow healing by secondary intention. The objective of this study was to determine the successful healing rate of wounds and identify the risk factors for failure. Methods : In this retrospective cohort study, we analyzed the efficacy of DPC for contaminated abdominal incisions after large bowel perforation in 21 patients between January 1, 2006 and December 31, 2007. The patient characteristics, risk factors for wound infection, and the clinical outcomes were compared in the DPC group versus the secondary healing group. Results : Seven wounds (33.3%) were closed by DPC and all healed successfully without development of wound infection. The remaining 14 wounds were considered to be unfavorable candidates for DPC and were allowed to heal by secondary intention. The percentage of patients who developed septic shock was significantly smaller (P=0.04) and the length of ICU stay was significantly shorter (P=0.03) in the delayed primary closure group. Conclusion : DPC of abdominal wounds is an effective method of wound management for contaminated abdominal wounds.
