Prospective randomized trial of two wound management strategies for dirty abdominal wounds.
OBJECTIVE
To determine the optimal method of wound closure for dirty abdominal wounds.


BACKGROUND
The rate of wound infection for dirty abdominal wounds is approximately 40%, but the optimal method of wound closure remains controversial. Three randomized studies comparing delayed primary closure (DPC) with primary closure (PC) have not conclusively shown any advantage of one method over the other in terms of wound infection.


METHODS
Fifty-one patients with dirty abdominal wounds related to perforated appendicitis, other perforated viscus, traumatic injuries more than 4 hours old, or intraabdominal abscesses were enrolled. Patients were stratified by cause (appendicitis vs. all other causes) and prospectively randomized to one of two wound management strategies: E/DPC (wound packed with saline-soaked gauze, evaluated 3 days after surgery for closure the next day if appropriate) or PC. In the E/DPC group, wounds that were not pristine when examined on postoperative day 3 were not closed and daily dressing changes were instituted. Wounds were considered infected if purulence discharged from the wound, or possibly infected if signs of inflammation or a serous discharge developed.


RESULTS
Two patients were withdrawn because they died less than 72 hours after surgery. The wound infection rate was greater in the PC group than in the E/DPC group. Lengths of hospital stay and hospital charges were similar between the two groups.


CONCLUSIONS
A strategy of DPC for appropriate dirty abdominal wounds 4 days after surgery produced a decreased wound infection rate compared with PC without increasing the length of stay or cost.
Division of Trauma and Surgical Critical Care, Department of Surgery, University of Miami School of Medicine, Miami, Florida 33136, USA. stephen.cohn@miami.edu
S M
SM
Cohn
G
G
Giannotti
A W
AW
Ong
J E
JE
Varela
D V
DV
Shatz
M G
MG
McKenney
D
D
Sleeman
E
E
Ginzburg
J S
JS
Augenstein
P M
PM
Byers
L R
LR
Sands
M D
MD
Hellinger
N
N
Namias
D018784:Abdominal Abscess / Q000601:surgery*; D000007:Abdominal Injuries / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001062:Appendectomy / Q000379:methods; D005260:Female; D005431:Florida / Q000453:epidemiology; D006801:Humans; D007416:Intestinal Perforation / Q000601:surgery*; D007813:Laparotomy / Q000379:methods; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control*; D013997:Time Factors; D014950:Wounds, Penetrating / Q000601:surgery*