Wound infection after ileostomy closure can be eliminated by circumferential subcuticular wound approximation

Wound infections after ileostomy closure are common with primary closure of the skin. Although this risk can be reduced by secondary closure, cosmetic outcomes are less than desirable. In an effort to balance these issues, we have used circumferential subcuticular wound approximation to decrease wound size. This study compares outcomes of primary closure vs. circumferential subcuticular wound approximation after ileostomy closure.

Forty-nine consecutive patients undergoing ileostomy closure over an 18-month period were reviewed. During the first half of this study, all ileostomy sites underwent primary closure, while during the second half all ileostomy sites underwent circumferential subcuticular wound approximation. Short-term outcomes were tabulated including wound infection. Long-term outcomes were assessed using a novel six-point patient satisfaction scale.

Primary closure was performed in 25 patients and circumferential subcuticular wound approximation performed in 24 patients. No wound infections occurred in the circumferential subcuticular wound approximation group, compared to 40 percent wound infection rate observed in the primary closure group (P = 0.002). The mean patient satisfaction score was higher in the circumferential subcuticular wound approximation group (18.4) vs. the primary closure group (15.9; P > 0.05).

Circumferential subcuticular wound approximation was associated with a significantly lower incidence of wound infection after ileostomy closure compared to primary closure. A trend was present toward better cosmetic results for circumferential subcuticular wound approximation than primary closure.