Comparison of primary and delayed wound closure of dog-bite wounds

Summary Background: Primary bite wound suturing in the emergency department remains controversial in some cases. Objective: We conducted a study to investigate the infection rate and cosmetic appearance between primary wound closure and delayed wound closure in dog bite wounds in humans. Methods: All patients with bite wounds were treated with oral antibiotic medications. We adopted a randomized cohort study, dividing the patients who needed wound closure into two groups: 60 patients for primary closure, and 60 patients for delayed closure, and compared the infection rate and wound cosmetic appearance scores. Results: In the primary closure group, four people (6.7%) developed a wound infection without systemic infection. In the delayed closure group, three people (5%) developed a wound infection (p = 0.093), but there were not any patients that developed a systemic infection. Thirty-three patients (55%) in the primary closure group had optimal cosmetic scores, whereas 20 patients (33.3%) in the delayed closure group had optimal cosmetic scores (p = 0.012). Conclusion: Although primary wound closure for dog bites may be associated with a higher infection rate, the cosmetic appearance after primary closure was still acceptable.

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Does primary closure for dog bite wounds increase the incidence of wound infection? A meta-analysis of randomized controlled trials

Journal of Plastic Reconstructive & Aesthetic Surgery ◽

10.1016/j.bjps.2014.05.051 ◽

2014 ◽

Vol 67 (10) ◽

pp. 1448-1450 ◽

Cited By ~ 11

Author(s):

Hsu-Tang Cheng ◽

Yung-Chang Hsu ◽

Chao-I. Wu

Keyword(s):

Randomized Controlled Trials ◽

Wound Infection ◽

Primary Closure ◽

Meta Analysis ◽

Controlled Trials ◽

Dog Bite ◽

Randomized Controlled ◽

Bite Wounds

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Surgical Site Infection Rate Drops to 0% Using a Vacuum-Assisted Closure in Contaminated/ Dirty Infected Laparotomy Wounds

The American Surgeon ◽

10.1177/000313481708300528 ◽

2017 ◽

Vol 83 (5) ◽

pp. 512-514 ◽

Cited By ~ 12

Author(s):

Gerardo Lozano-Balderas ◽

Alejandro Ruiz-Velasco-Santacruz ◽

Jose Antonio Diaz-Elizondo ◽

Juan Antonio Gomez-Navarro ◽

Eduardo Flores-Villalba

Keyword(s):

Surgical Site Infection ◽

Infection Rate ◽

Primary Closure ◽

Statistical Significance ◽

Site Infection ◽

Class Iii ◽

Infection Rates ◽

Vacuum Assisted Closure ◽

Significant Difference ◽

Delayed Closure

Wound site infections increase costs, hospital stay, morbidity, and mortality. Techniques used for wounds management after laparotomy are primary, delayed primary, and vacuum-assisted closures. The objective of this study is to compare infection rates between those techniques in contaminated and dirty/ infected wounds. Eighty-one laparotomized patients with Class III or IV surgical wounds were enrolled in a three-arm randomized prospective study. Patients were allocated to each group with the software Research Randomizer® (Urbaniak, G. C, & Plous, S., Version 4.0). Presence of infection was determined by a certified board physician according to Centers for Disease Control's Criteria for Defining a Surgical Site Infection. Twenty-seven patients received primary closure, 29 delayed primary closure, and 25 vacuum-assisted closure, with no exclusions for analysis. Surgical site infection was present in 10 (37%) patients treated with primary closure, 5 (17%) with primary delayed closure, and 0 (0%) patients receiving vacuum-assisted closure. Statistical significance was found between infection rates of the vacuum-assisted group and the other two groups. No significant difference was found between the primary and primary delayed closure groups. The infection rate in contaminated/dirty-infected laparotomy wounds decreases from 37 and 17 per cent with a primary and delayed primary closures, respectively, to 0 per cent with vacuum-assisted systems.

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Definitive Wound Closure Techniques in Fournier's Gangrene

The American Surgeon ◽

10.1177/000313481808400127 ◽

2018 ◽

Vol 84 (1) ◽

pp. 86-92

Author(s):

Margaret Lauerman ◽

Olga Kolesnik ◽

Habeeba Park ◽

Laura S. Buchanan ◽

William Chiu ◽

...

Keyword(s):

Wound Healing ◽

Confidence Interval ◽

Odds Ratio ◽

Primary Closure ◽

Wound Closure ◽

Fournier’S Gangrene ◽

Fournier's Gangrene ◽

Secondary Intention ◽

Primary Wound Closure

Necrotizing soft tissue infection of the perineum, or Fournier's gangrene (FG), is a morbid and mortal diagnosis. Despite the severity of FG, the optimal definitive wound closure strategy is unknown, as are long-term wound outcomes. A retrospective review was performed over a 3-year period at a single trauma center. Patients were managed according to our institutional approach focusing on primary wound closure and secondary intention healing in residual wounds. Overall 168 patients were included. Complete primary wound closure was accomplished in 39.9 per cent of patients. Patients undergoing primary wound closure were primarily male (89.6 vs 64.4%, P < 0.001), had lower mean sequential organ failure assessment (SOFA) scores (1.70 ± 2.30 vs 2.98 ± 3.36, P = 0.004), more often had perineum-limited FG (67.2 vs 42.6%, P = 0.003), and required fewer debridements (2.40 vs 2.79, P = 0.02). On logistic regression, predictors of primary closure included gender (odds ratio 4.643, 95% confidence interval 1.885–11.437, P = 0.001) and SOFA score (odds ratio 0.834, 95% confidence interval 0.727–0.957, P = 0.01). Wound healing rates increased over time, to an 82.1 per cent wound healing rate without further intervention at greater than six months of follow-up. Wounds healed with secondary intention ranged from 70 to 9520 cm3 and primary closure ranged from 126 to 6912 cm3, whereas wounds requiring skin grafts ranged from 405 to 16,170 cm3. Complete primary wound closure is often achievable in FG patients. Using this standardized approach to FG wound management, even large wounds and wounds undergoing secondary intention healing will often close with long-term wound care and do not require flap creation or early skin grafting.

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Primary versus delayed wound closure technique in laparotomy wound of perforation peritonitis

International Surgery Journal ◽

10.18203/2349-2902.isj20194429 ◽

2019 ◽

Vol 6 (10) ◽

pp. 3708

Author(s):

M. N. Sasikumar ◽

Sam Christy Mammen

Keyword(s):

Hospital Stay ◽

Wound Infection ◽

Primary Closure ◽

Wound Closure ◽

Wound Dehiscence ◽

Infection Rates ◽

Saline Irrigation ◽

Primary Wound Closure ◽

Group A ◽

Perforation Peritonitis

Background: There is no consensus on the ideal techniques for wound closure of contaminated wounds. Multiple techniques have been proposed. The aim of the study is to compare the wound infection rates of laparotomy wounds in perforation peritonitis in primary and delayed primary wound closure. The purpose is comparison of primary wound closure and delayed primary wound closure with respect to rate of wound infection and other associated complications like wound dehiscence, stitch sinuses, incisional hernias and duration of hospital stay.Methods: This study included 106 patients, divided into two groups, primary closure (A) in which wound was primarily closed and secondary closure (B) in which wound was left open without suturing and saline irrigation was given and were sutured once the wound is clean and culture sterile. The wound infection was assessed using Southampton scoring system.Results: A total of 106 patients, 60 (56.6%) males and 46 (43.4%) females were included. Group A, 53 patients with 54.7% males and 45.3% females and in B, 53 patients with 58.5% males and 41.5% females. The mean age in A was 38.4 11.8while that in B 37.02 12.59. Group A had an infection rate of 77.4%whereas group B had only 34%. The duration of hospital stay for B was 9.72 2.57 and for group A, 11.74 2.87days.Conclusions: The delayed primary closure is the optimal technique for wound closure in contaminated wounds like perforation peritonitis as it reduces wound infection rates and hospital stay.

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Evaluation of partial wound closure in perforated appendicitis

International Surgery Journal ◽

10.18203/2349-2902.isj20193316 ◽

2019 ◽

Vol 6 (8) ◽

pp. 2726

Author(s):

Muhammed H. Jaafar Al-Sa'adi ◽

Ali Laibi Zamil

Keyword(s):

Acute Appendicitis ◽

Wound Infection ◽

Primary Closure ◽

Wound Closure ◽

Perforated Appendicitis ◽

Pathological State ◽

Open Wound ◽

Primary Wound Closure ◽

Delayed Primary Closure ◽

Hospital Stays

Background: Perforated appendicitis is a serious complication of acute appendicitis that usually occurs due to over delay in presentation, diagnosis, and surgical treatment. Wound infection is one of the important sequelae of perforated appendicitis. Method of the wound closure in perforated appendicitis is a critical factor that affects the incidence of wound infection and there is continuing controversy about the best method.Methods: 362 patients with a diagnosis of acute appendicitis were enrolled in a prospective randomized study that extended over three years. The intraoperative gross pathological state of the appendix was recorded as either negative or uncomplicated or perforated appendicitis. The relationship between the wound infection with each one of the three methods of wound closure (primary closure, open wound with delayed primary closure and partial wound closure) had been reported. The hospital stays were recorded for each method.Results: 18.78% of appendectomy was appendicitis negative, 62.98% uncomplicated appendicitis and 18.23% with perforated appendicitis. In the perforated appendicitis cases, Primary wound closure was used in 36.36%, open method and delay primary closure in 18.18% and partial wound closure in 45.45%. The wound infection rates were 37.5%, 16.66% and 13.33% in primary wound closure, open wound with delayed primary closure and partial wound closure respectively. Length of hospital stays were 7 days, 8 days and 4 days respectively.Conclusions: partial wound closure is superior to other methods of wound closure, which are primary wound closure and open wound with delayed primary wound closure.

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Management of Animal Bite Wounds on Face: Our Experience

World Journal of Dentistry ◽

10.5005/jp-journals-10015-1103 ◽

2011 ◽

Vol 2 (4) ◽

pp. 309-311

Author(s):

G Anup Kumar ◽

Abhishek Mathur ◽

Keerthi Ramesh

Keyword(s):

Surgical Treatment ◽

Antibiotic Prophylaxis ◽

Wound Closure ◽

Common Complication ◽

Wound Debridement ◽

Plastic Reconstruction ◽

Primary Wound Closure ◽

Animal Bites ◽

Bite Wounds

ABSTRACT Bite wounds are among the commonest types of trauma to which the man is subjected. Infection is the most common complication in animal bite wounds. The surgical treatment of facial animal bites remains a source of controversy. The controversies continue to center on the timing of wound debridement and primary wound closure as well as the use of antibiotic prophylaxis and primary plastic reconstruction. We report 30 cases of animal bites treated in our department and our protocol in the management of the same.

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INFLUENCE OF DIFFERENT INCISION DESIGNS ON FLAP EXTENSION: A CADAVERIC ANIMAL MODEL

Journal of Oral Implantology ◽

10.1563/aaid-joi-d-20-00026 ◽

2020 ◽

Author(s):

Bassel Traboulsi Garet ◽

Albert González Barnadas ◽

Octavi Camps Font ◽

Rui Figueiredo ◽

Eduard Valmaseda-Castellón

Keyword(s):

Animal Model ◽

Bone Regeneration ◽

Primary Closure ◽

Wound Closure ◽

Wound Dehiscence ◽

Guided Bone Regeneration ◽

The Other ◽

Primary Wound Closure ◽

Flap Design ◽

Two Sides

It is well known that wound dehiscence is one of the most frequent complications in guided bone regeneration. The main cause of this complication may be a lack of tension-free and primary wound closure. The aim of this study was to evaluate and compare the effect of periosteal releasing incisions (PRI) upon the extension of three different flap designs: envelope, triangular and trapezoidal flaps. Twelve pig mandibles were used to quantify extension of the flap designs. The mandibles were equally and randomly distributed into the three flap groups. Each mandible was divided into two sides: one was subjected to a PRI and the other not. The flap was pulled with a force of 1.08 N and the extension was recorded. The subgroups without PRI showed an average extension of 5.14 mm, with no statistically significant differences among them (p = 0.165). The PRI provided an average extension of 7.37 mm with statistically significant differences among the subgroups (p < 0.001). The releasing incisions significantly increased flap extension in each flap design. The increase in extension of the trapezoidal flap with PRI was significantly greater than in the other subgroups. In cases where primary closure is required, surgeons should consider performing trapezoidal flaps with PRI in order to reduce tension.

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