scholarly journals A randomised study to evaluate wound outcome following delayed primary vs primary closure of skin in duodenal perforation peritonitis

2021 ◽  
Vol 8 (7) ◽  
pp. 2108
Author(s):  
Sajal Gupta ◽  
Vimal Bhandari ◽  
I. B. Dubey
Keyword(s):  
Primary Closure ◽  
Surgical Site Infections ◽  
Wound Dehiscence ◽  
Duodenal Perforation ◽  
P Value ◽  
Randomised Study ◽  
Delayed Primary Closure ◽  
Significant Difference ◽  
Perforation Peritonitis ◽  
Stitch Abscess

Background: This study aimed to evaluate wound outcome following delayed primary versus primary closure of skin in duodenal perforation peritonitis.Methods: The present study was a randomised interventional study that included 90 patients on accrual of duodenal perforation peritonitis which were divided into primary closure (PC) and delayed primary closure (DPC) groups comprising 45 patients each. The outcome measures were complications, surgical site infections, hospital stay and final wound status during the follow up of 30 days. Data collected was compared taking P-value <0.05 as significant.Results: The patients were in the age group of 12–60 years, with men in majority in both groups. Mean SSI score in PC and DPC was comparable (2.67 SD 1.58 vs. 2 SD1.61, P=0.058). SSI was more in PC group than DPC group (11.11% vs. 2.22%, P<0.05). Wound/pus culture was positive in 62.22% in PC and 46.67% in DPC. Major complications like wound dehiscence was noticed mainly in PC group while minor Complications like Stitch abscess, granuloma, sinus was more in DPC group. Mean of duration of stay (days) was comparable between PC and DPC group (14.07 SD 7.64 vs. 13.96 SD 6.94, P=0.805). Final wound outcome after 30 days was healthy scar in majority of patients in PC and DPC group (57.78% vs. 66.67%) with no significant difference between them (p=0.434).Conclusions: In conclusion, DPC showed comparable results with PC with similar SSI and wound healing without significant complications.

scholarly journals A comparative study on surgical site infections after primary closure and delayed primary closure in clean contaminated laparotomy cases

2019 ◽  
Vol 6 (3) ◽  
pp. 989
Author(s):  
T. J. Pauly ◽  
T. V. Haridas ◽  
E. Manoj Prabhakar ◽  
Roshjo Roshan
Keyword(s):  
Surgical Site Infection ◽  
Primary Closure ◽  
Surgical Site Infections ◽  
P Value ◽  
Skin Closure ◽  
Site Infection ◽  
Chi Square ◽  
Delayed Primary Closure ◽  
Laparotomy Wound ◽  
Clean Contaminated

Background: Surgical site infection is a significant cause of post operative morbidity. Timing of skin closure following a surgery and its relation to incidence of infection has been studied. The debate whether primary or delayed primary closure have been around for a long time. The aim of this study is to compare the rate of infection in a laparotomy wound in clean contaminated laparotomy cases after primary and delayed primary closure.Methods: 132 patients who underwent laparotomy for clean contaminated were selected. Of this primary closure of the skin was done in 66 cases and delayed primary closure at 48 hours were done in the other 66 patients. Wounds were followed up till post op day 7. The results between two groups were compared using chi square test.Results: two out of 66 cases developed SSI in the delayed primary sutured group whereas 8 out of 66 cases developed SSI in primary suturing group. The results were compared using chi square test and the chi square statistic was 3.8951 and the p value is 0.048428 (<0.05) proving the result significant.Conclusions: The incidence of surgical site infection in laparotomy wound after a primary closure was higher compared to delayed primary closure in clean contaminated laparotomy wounds and the difference is significant based on statistical evaluation.

scholarly journals Delayed Primary Closure of Wound Prevents Wound Infection after Surgery in Patients with Obstructive Jaundice

2020 ◽  
Vol 14 (1) ◽  
pp. 37-40
Author(s):  
Md Aslam Hossain ◽  
Md Julfiqur Rahman Khan ◽  
SM Rokonuzzaman ◽  
Md Maniruzzaman Khan ◽  
Md Mobaraque Hossain Khan ◽  
...  
Keyword(s):  
Obstructive Jaundice ◽  
Surgical Site Infection ◽  
Wound Infection ◽  
Primary Closure ◽  
Wound Dehiscence ◽  
Control Group ◽  
Site Infection ◽  
Septic Complications ◽  
Delayed Primary Closure ◽  
Experimental Group

Surgery in jaundiced patients is associated with a higher risk of postoperative complications compared with surgery in non jaundiced patients. These complications primarily consists of septic complications, hemorrhage, superficial surgical site infection (SSSI), wound dehiscence and renal disorders. Of them Surgical Site Infection (SSI) is found more commonly than other. This study was done to evaluate the effect of delayed primary closure on preventing wound infection than that of primary closure of wound after surgery in patients with obstructive jaundice. This randomized clinical trial was carried out at the Hepatobiliary and Pancreatic division of Department of Surgery in Bangabandhu Sheikh Mujib Medical University, Dhaka from July 2012 to June 2013. A total of 88 patients were included in this study who underwent surgical intervention for obstructive jaundice. These patients were divided into two groups randomly; control group (n=44) who underwent primary closure of the wound and experimental group (n=44) who underwent delayed primary closure of the wound. Patients demography, clinical presentation, comorbidities, pre, per and post operative variables and outcome were compared between two groups. Mean age of the patients of experimental and control group was 47.91± 14.63 and 42.25±12.13 years respectively. Duration of jaundice was significantly higher in experimental group 4.91±2.87 months than in control group 3.10±1.62 months. Postoperative wound infection was found significantly higher in control group (43.2%) than that of experimental group (11.4%). Postoperative hospital stay was significantly longer in control group (18.77± 6.24 days) than in experimental group (13.52±3.61 days). Delayed primary closure of wound reduces wound infection significantly than primary closure of wound in patients with obstructive jaundice. Faridpur Med. Coll. J. Jan 2019;14(1): 37-40

scholarly journals Conventional incision and drainage versus incision and drainage with primary closure in acute abscess: a prospective study

2017 ◽  
Vol 5 (1) ◽  
pp. 281
Author(s):  
Amandeep Singh ◽  
Gurdhian Singh ◽  
Darsshan Singh Sidhu ◽  
Mohit Bhalla
Keyword(s):  
Wound Healing ◽  
Hospital Stay ◽  
Recurrence Rate ◽  
Conventional Method ◽  
Primary Closure ◽  
The Body ◽  
P Value ◽  
Incision And Drainage ◽  
Significant Difference ◽  
A Prospective Study

Background: An abscess is a common surgical condition. Abscesses may occur anywhere in the body. Surgical treatment of subcutaneous and soft tissue abscesses includes percutaneous aspiration, incision and drainage without primary closure, incision and drainage with primary closure with drain. The present study was planned to compare conventional method of incision and drainage with incision and drainage with primary closure in cases of acute -abscesses.Methods: A total of 100 patients with acute abscesses were included in the study and randomized into 2 groups with 50 patients in each group. The present study was carried out to compare the conventional method of incision and drainage with incision and drainage with primary closure of the wounds in acute abscesses with regards to wound healing, post- operative pain, duration of hospital stays and recurrence rates.Results: Wound healing was significantly faster in incision and drainage with primary closure (9.18±0.941days) as compared to conventional method of incision and drainage (16.66±1.944 days) [p <0.05]. Mean hospital stay with convention method of incision and drainage was 7.12±0.718 days and with primary closure was 4.0±0.728days (p <0.05). Mean VAS was significantly less in primary closure as compared with conventional method. Decreasing trend in VAS was observed on day 3, day 5 and day 7 (p value 0.000). Recurrence rate of an abscess was seen in 5 cases in conventional method and 2 cases in primary closure (p >0.05).Conclusions: Author have observed a significant difference noted in time taken for wound healing, postoperative pain, hospital stay and recurrence rate between two groups.

scholarly journals Role of subcutaneous suction drain in reducing surgical site infections after emergency laparotomy

2017 ◽  
Vol 4 (8) ◽  
pp. 2717
Author(s):  
Poonam Gupta ◽  
Rajesh Kumar
Keyword(s):  
Surgical Site Infection ◽  
Significant Role ◽  
Surgical Site Infections ◽  
P Value ◽  
Emergency Laparotomy ◽  
Emergency Setting ◽  
Site Infection ◽  
Randomised Study ◽  
Suction Drain ◽  
Drain Group

Background: One of important morbidity postoperatively is surgical site infection and the important cause is collection of blood and serous fluids which can get infected and this factor is even more important in emergency laparotomies. our prospective randomised study compares the incidence of surgical site infection in post emergency abdominal surgical wounds with subcutaneous suction drains versus those in whom drain was not placed.Methods: A prospective interventional study of 100 subjects done in department of surgery at rural tertiary centre. on the basis of exclusion and inclusion criteria patient were randomly selected for cases (with post-operative suction drain) and controls. subcutaneous drain in emergency setting play significant role in reducing the incidence of surgical site infection which is significant statistically.Results: 24% of patients in drain group develop surgical site infections. 50% of patients in non-drain group develop infection. Incidence of infection in drain group was lower than the no drain group (p value 0.05) and was statistically significant.Conclusions: Subcutaneous drain in emergency laparotomy play significant role in reducing the incidence of surgical site infection

scholarly journals Surgical sequale of transabdominal preperitoneal approach versus Lichtenstein open repair in a rural setting

2021 ◽  
Vol 8 (8) ◽  
pp. 2341
Author(s):  
Chanthu C. Nair ◽  
Karthikeyan E. M. J.
Keyword(s):  
Surgical Site Infections ◽  
Rural Setting ◽  
Perioperative Outcomes ◽  
P Value ◽  
Transabdominal Preperitoneal ◽  
Group Data ◽  
Preperitoneal Approach ◽  
Significant Difference ◽  
Open Versus ◽  
Repair Group

Background: The objective was to compare the outcomes perioperative outcomes of transabdominal preperitoneal approach (TAPP) versus Lichtenstein tension (open) free repair for adult unilateral uncomplicated inguinal hernia patients (including both direct and indirect hernias).Methods: The prospective study was conducted between July 2018 to August 2020. A total of 60 patients, 30 in the Lichtenstein tension free repair group and 30 in the TAPP repair group data were collected and analysed.Results: The mean age was 55 in our study. On comparing open versus TAPP, significant difference of p value ≤0.05 was observed in terms of surgical site infections, time to discharge, time to return to work and mesh related pain in TAPP. Operative time was shorter in open group.Conclusions: Laparoscopic transabdominal preperitoneal repair is a valid alternative to open traditional method with lesser morbidity to the patients.

TP6.2.1 Does the use of Negative Pressure Wound Dressings decrease superficial Surgical Site Infections in the Emergency Laparotomy?

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Eleanor Smith ◽  
Hannah Merriman ◽  
Safia Haidar ◽  
Grace Knudsen ◽  
Victoria Kinkaid ◽  
...  
Keyword(s):  
Negative Pressure ◽  
Intervention Group ◽  
Surgical Site Infections ◽  
Wound Dehiscence ◽  
Wound Dressings ◽  
Emergency Laparotomy ◽  
Post Intervention ◽  
Significant Difference ◽  
The Cost

Abstract Aims Surgical site infection (SSI) can be a significant cause of morbidity in the emergency laparotomy patient. Previous research into the role of negative pressure wound dressings to improve the rate of SSI culminated with NICE guidelines in 2019 recommending the use of negative pressure wound dressings in people who would be considered high risk for developing an SSI. Based on this guideline, we changed our policy to recommend the use of PICO dressings for all emergency laparotomies in order to decrease our rate of SSI. Our aim of this study was to assess the success of this policy change. Methods In this closed-loop audit we analysed data from all laparotomy patients at Frimley Park Hospital over 12 months. We retrospectively analysed the data of the pre-intervention group between January – June 2019, and prospectively audited all laparotomy patients between July – December 2019. Results We found that there was no significant decrease in the rate of superficial SSI, from a pre intervention rate of 22.2% to a post intervention 24.1%. Similarly, we found no significant decrease in the rate of wound dehiscence, which increased from 13.8% to 17.7%. In further assessment we saw no significant difference in the rates of contamination, ASA grades, or closure techniques to account for these increased rates. Conclusion While other studies have demonstrated a decrease in SSIs following the use of PICO dressings, we did not show such a result, leading us to question the cost-effectiveness of negative pressure wound dressings in the emergency laparotomy patient.

scholarly journals Effect of duration of pre-operative admission on surgical site infection in major abdominal surgeries: an observational study

2019 ◽  
Vol 8 (6) ◽  
pp. 2306
Author(s):  
Alka Shantiprakash Gupta ◽  
Arthika Shetty
Keyword(s):  
Surgical Site Infection ◽  
Surgical Site Infections ◽  
Surgical Patient ◽  
P Value ◽  
Site Infection ◽  
Admission Time ◽  
Long Run ◽  
Skin Flora ◽  
Significant Difference ◽  
Prolonged Hospital

Background: Surgical site infection (SSI) are second most common cause of mortality in surgical patient, situation has been further complicated by emergence of drug resistant strains. The importance of preventing surgical site infections is well recognized since they lead to increased morbidity, prolonged hospital stays, need for readmission, high end antibiotic treatment and re-surgery. The study was done to see if   incidence of SSI is decreased with decreased pre-operative admission time. Others factors associated with SSI were analysed including the microbiological spectrum.Methods: The study was an analytical, observational, case control study. Sixty (60) cases each of gynaecology and obstetrical post-operative patients who developed SSI within 30 days were taken as cases and who did not develop SSI were taken as controls and preoperative admission time was analysed in both cases and controls to observe if risk of surgical site infections decreases due to decreased exposure to nosocomial pathogens when the pre-operative admission time was less than 48 hours.Results: Author found that there was statistically significant difference in the time between surgery and admission in the gynaecological surgeries with p value 0.023, as compared to the obstetrics surgeries where there was no statistically significant difference. Common organism isolated was E. coli sensitive to gentamicin.Conclusions: From this study, it seems to be a good policy to evaluate the patient on OPD basis and admit them about 24 to 48 hours prior to the surgery rather them keeping them admitted for prolonged duration in wards for diagnostic evaluation. This prevents nosocomial contamination in the patient’s skin flora thereby preventing SSI. This practice not only conserves the hospital resources but also makes the patient turn over faster. Further this might in the long run reduce the antibiotic resistant hospital flora.

scholarly journals Randomized control trial comparing primary hip spica versus initial traction and hip spica of fracture at or below the junction of the upper and middle third of femur in children

2017 ◽  
Vol 13 (2) ◽  
pp. 80-91
Author(s):  
Pashupati Chaudhary ◽  
AR Bajracharya ◽  
A Joshi ◽  
B Sharma ◽  
R Bose ◽  
...  
Keyword(s):  
Pediatric Population ◽  
Femoral Shaft ◽  
Wound Dehiscence ◽  
P Value ◽  
Chi Square ◽  
Spica Casting ◽  
Femur Fractures ◽  
Fractures In Children ◽  
Group I ◽  
Significant Difference

Background: The debate regarding optimal management of femoral shaft fractures in the pediatric population is still far from resolved. While some consensus exists in the treatment of this injury in children younger than the age of six, opinion still widely divided in children six to 11 years.Objective: The aim of study was to compare the outcome of primary hip spica versus initial traction and hip spica of fracture of shaft of femur at or below the junction of the upper and middle third in children in terms of deformity and fracture healing.Method: A RCT study was carried out in the departments of Orthopedics, B.P.Koirala Institute of Health Sciences, Dharan, Nepal from March 2004 to January 2006. Forty five patients were included in the study in which 22 patients included in early spica casting (group I) and 23 patients in traction with spica casting (group II). The functional outcomes were assessed with Pearson’ Chi-square test, Independent samples test and union was assessed radiologically.Result: There was no statistically significant difference in time of union; all of them united in 8-10 weeks follow up. No significant overall difference in terms of deformity was noted in the two groups(p value-0.306).There was significant difference in terms of hospital stay in both the groups(p value<0.05).Conclusion: The study showed that there is significant advantage in primary hip spica cast for the treatment of isolated , closed femur fractures in children ages less than 10 years and weight less than 80 pounds(45kg) which allowed us to treat these fractures without any worry of wound dehiscence, pin site infections, avascular necrosis of the femoral head.Health Renaissance 2015;13(2): 80-91

Damage Control Laparotomy Wound Incisions Can Be Closed With Low Rates of Superficial Surgical Site Infections

2021 ◽  
pp. 000313482110545
Author(s):  
John D. Cull ◽  
Kristen A. Spoor ◽  
Katherine F. Pellizzeri ◽  
Benjamin M. Manning
Keyword(s):  
Retrospective Review ◽  
Primary Closure ◽  
Damage Control ◽  
Surgical Site Infections ◽  
Fascial Closure ◽  
Damage Control Laparotomy ◽  
Secondary Intention ◽  
Delayed Primary Closure ◽  
Laparotomy Wound

Due to high rates of surgical site infections (SSIs) in damage control laparotomies (DCLs), many surgeons leave wounds to heal by secondary intention. We hypothesize that patients after DCL can have their wounds primarily closed with wicks/Penrose drains with low rates of superficial surgical site infections. A retrospective review of a prospectively maintained DCL database was performed for all patients who underwent DCL from January 2016 to June 2018. From January 2016 to June 2018, a total of 171 patients underwent DCL. After exclusions, 107 patients were reviewed to assess for SSI. 57 patients were closed with wicks/Penrose drains, 3 were closed with delayed primary closure, and 47 patients were closed completely at time of fascial closure. There were 4 (3.7%) superficial SSIs, 13 (12.1%) organ space infections, and 14 surgical site occurrences (3 of which required opening the skin). Primary closure of incisions after DCL has low superficial SSI rates.

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