Cierre primario diferido en pacientes laparotomizados de emergencia con índice SENIC ≥ 3 puntos / Deferred primary closure in emergency laparotomized patients with SENIC index ≥ 3 points

Las infecciones del sitio operatorio representan un desafío en el entorno hospitalario. El cierre primario diferido ha surgido como técnica para prevenirlas. Esta investigación busca explorar los beneficios del cierre primario diferido en la reducción de infecciones, estancia hospitalaria y costos, mejorando los resultados clínicos en cirugías abdominales. Objetivos. Evaluar el cierre primario diferido en pacientes laparotomizados de emergencia que acuden Hospital Universitario de Mérida ­Venezuela, con índice SENIC ≥ 3 puntos. Métodos. Se llevó a cabo un estudio experimental prospectivo para evaluar los efectos del cierre primario diferido en comparación con el cierre primario en laparotomías exploradoras. La muestra consistió en 160 pacientes. Se analizaron la presencia de infecciones, la duración de la estancia hospitalaria y la evolución temporal de las infecciones como desenlaces del estudio. Resultados. Se encontró que el cierre primario diferido redujo la presencia de infecciones en comparación con el cierre primario. La limpieza trans-operatoria y el diagnóstico de abdomen agudo quirúrgico infeccioso fueron factores beneficiosos. La antibioticoterapia continua en el postoperatorio también fue más efectiva. Se observó una disminución del riesgo de infección en el grupo experimental en un 37% en comparación con el grupo de control. Conclusiones. El cierre primario diferido de la herida reduce significativamente la probabilidad de infección del sitio operatorio en cirugías abdominales con heridas contaminadas. Es una técnica beneficiosa para pacientes con abdomen agudo quirúrgico infeccioso. Además, el cierre primario diferido resulta rentable al disminuir tanto la incidencia de ISO como la duración de la estancia hospitalaria

Surgical site infections pose a challenge in the hospital setting. Delayed primary closure has emerged as a technique to prevent such infections. This research aims to explore the benefits of delayed primary closure in reducing infections, hospital stay, and costs, thus improving clinical outcomes in abdominal surgeries. Objectives. To evaluate delayed primary closure in emergency laparotomized patients with SENIC index ≥ 3 points at the University Hospital of Mérida, Venezuela. Methods. A prospective experimental study was conducted to assess the effects of delayed primary closure compared to primary closure in exploratory laparotomies. The sample consisted of 160 patients. The presence of infections, duration of hospital stay, and temporal evolution of infections were analyzed as study outcomes. Results. Delayed primary closure was found to reduce the presence of infections compared to primary closure. Transoperative cleaning and the diagnosis of infectious surgical acute abdomen were beneficial factors. Continuous postoperative antibiotic therapy was also more effective. A 37% reduction in the risk of infection was observed in the experimental group compared to the control group. Conclusions. Delayed primary closure significantly reduces the probability of surgical site infection in abdominal surgeries with contaminated wounds. It is a beneficial technique for patients with infectious surgical acute abdomen. Additionally, delayed primary closure proves cost-effective by reducing both the incidence of surgical site infections and the duration of hospital stay(AU)

Comparative study of delayed primary closure by shoelace technique versus conventional secondary suturing method in closure of fasciotomy wounds, done for spreading cellulitis with compartment syndrome

Background: Fasciotomy is a standard treatment for acute compartment syndrome. Historically, fasciotomy incisions were usually left open till oedema settles down. In literature, there is a wide range of wound closure techniques published, but none of them is deemed to be the best. In this study, focus is laid on whether delayed primary closure (DPC) by shoelace technique, is as effective as conventional secondary suturing, in closure of fasciotomy wounds, done for spreading cellulitis.Methods: All those patients who met below mentioned inclusion criteria and underwent fasciotomy, were allocated into 2 groups (A and B) where Group A consists of 30 patients undergoing conventional secondary suturing, whereas Group B consists of 30 patients undergoing DPC by shoelace technique for closure of fasciotomy wounds. Parameters such as duration of hospital stay, time taken for complete wound closure, local wound complications, hospital expenses, anaesthesia related complications between the two groups were compared.Results: Patients who underwent DPC for fasciotomy wound closure achieved wound closure ~7 days earlier with 5 days lesser hospital stay than that of those who underwent conventional secondary suturing. Average health care cost of Group B was significantly lower compared to Group A, but there was no statistically significant difference in incidence of wound infections between the two groups.Conclusions: DPC by shoelace technique, takes less time for wound closure and hence the need for nursing care and hospital stay is significantly reduced in comparison to the conventional secondary suturing method.

Comparative study of delayed primary closure versus primary closure of skin in contaminated and dirty abdominal wounds/ incision

Background: It is still a matter of debate whether delayed primary closure (DPC) of contaminated abdominal incision reduces surgical site infection compared with primary closure (PC ).The rate of wound infection for dirty abdominal wound is approximately 40%, but the optimal method of wound closure remains controversial. Aims and objectives: To determine whether delayed primary skin closure of contaminated and dirty abdominal wounds reduces the rate of surgical site infection (SSI) compared with primary skin closure. Method: Patient diagnosed as acute peritonitis and posted for exploratory laparotomy during the period of October 1 2013 to September 1 2015 were included. The study was conducted at Shri B M Patil Medical College and Hospital, Bijapur. In this series a total of 100 patients were included and were divided in two groups. Each group had 50 patients. For primary closure group, wounds were closed with monofilament interrupted suture. For Delayed primary closure, skin and subcutaneous tissue are left open and packed with 10 % (betadine) povidone iodine soaked gauge, which was changed daily to prevent excessive collection of exudates. The outcome of wound was assessed on post –operative days. Result: In this entire series, wound infection developed after incision closure was 33% .The primary group had a higher rate of wound infection 54% and delayed primary closure was 12% (P<0.001) and longer length of hospital stay 19.4days in primary closure group and 16.5days in delayed primary closure group (P<0.002). Conclusion: Laparotomy wound complications are multifactorial, it depends on many factors. A strategy of DPC of dirty abdominal wound, clinically appears to decrease the rate of wound infection, when compared with PC without increasing the length hospital of stay.