Contaminated wounds: the effect of initial management on outcome

Delayed primary closure has been advocated as the optimal method of management in the presence of wound contamination. The present study was performed to determine whether surgeons have accepted this standard. A total of 918 surgical wounds were evaluated and classified according to the level of con...

Full description

Saved in:
Bibliographic Details
Published inThe American surgeon Vol. 61; no. 5; p. 427
Main Authors Smilanich, R P, Bonnet, I, Kirkpatrick, J R
Format Journal Article
LanguageEnglish
Published United States 01.05.1995
Subjects
Anti-Bacterial Agents - therapeutic use
Cellulitis - etiology
Debridement
Dermatologic Surgical Procedures
Drainage
Enterobacter
Enterobacteriaceae Infections
Escherichia coli Infections
Fasciitis - etiology
Fasciotomy
Humans
Length of Stay
Necrosis
Reoperation
Retrospective Studies
Suppuration
Surgical Wound Infection - classification
Surgical Wound Infection - prevention & control
Surgical Wound Infection - therapy
Treatment Outcome
Online AccessGet more information

Cover

More Information
Summary:Delayed primary closure has been advocated as the optimal method of management in the presence of wound contamination. The present study was performed to determine whether surgeons have accepted this standard. A total of 918 surgical wounds were evaluated and classified according to the level of contamination and type of wound management used. We found that 150 patients had a Class III or Class IV contaminated wound; however, only 21 per cent were treated with delayed primary closure. The 118 patients treated with primary closure and antibiotics had an aggregate wound infection rate of 27 per cent (Class III-29%; Class IV-24%). Only one (3%) of the wounds managed by delayed primary closure developed an infection. If infection did not occur, there was no difference in the length of stay between patients managed with primary closure and delayed primary closure. However, there was a significantly longer length of stay in the primary closure group if infection occurred. Benefit risk analysis of the patients with contaminated wounds confirmed that in this clinical setting, delayed primary closure remains the optimal method of management for the wound.
ISSN:0003-1348