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Medline ® Abstract for Reference 16

of 'Complications of abdominal surgical incisions'

Prospective randomized trial of two wound management strategies for dirty abdominal wounds.
Cohn SM, Giannotti G, Ong AW, Varela JE, Shatz DV, McKenney MG, Sleeman D, Ginzburg E, Augenstein JS, Byers PM, Sands LR, Hellinger MD, Namias N
Ann Surg. 2001;233(3):409.
OBJECTIVE: To determine the optimal method of wound closure for dirty abdominal wounds.
SUMMARY BACKGROUND DATA: 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 postoperativeday 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RESULTS: Two patients were withdrawn because they died less than 72 hours after surgery.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.
CONCLUSION: 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