An Inexpensive Modified Primary Closure Technique for Class IV (Dirty) Wounds Significantly Decreases Superficial and Deep Surgical Site Infection
Bradford J Kim1, Thomas A Aloia2
1Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1400 Herman Pressler Drive, Unit 1484, Houston, TX, 77030, USA.
Abstract:
Despite the creation of several programs to decrease the incidence of surgical site infection, it remains a common complication that has a significant impact on patient recovery and medical costs. The following is a description and brief outcome report of a modified primary closure technique used for dirty (Class IV) wounds. There were 14 consecutive patients who had a laparotomy with Class IV wounds treated by a single surgeon (TAA) from 2011 to 2015. All patients had a history of cancer and either showed signs suggestive for an acute abdomen and required an emergent exploratory laparotomy or were found to have purulent intraabdominal infection at the time of elective surgery. The operation and "modified primary closure" technique (subcutaneous wound wicks with stapled skin closure) were performed in every case. The modified primary closure technique was utilized in 14 patients with a Class IV wound. There were no 30-day mortalities or readmissions. Wound wicks were slowly advanced out over a 7-day period, and only one patient required subsequent wound packing of a single-wicked area. There were no superficial or deep surgical site infections, or wound dehiscence during the hospital course, or 30-day postoperative period. The modified primary closure technique is efficient and inexpensive and was effective in a series of 14 patients with wounds classified as dirty.
Insights
A modified primary closure technique using subcutaneous wound wicks and stapled skin closure effectively managed dirty (Class IV) surgical wounds in 14 patients. This approach prevented surgical site infections and complications, offering an efficient and inexpensive solution.
Area of Science:
- Surgical Innovation
- Infectious Disease Control
- Wound Management
Background:
- Surgical site infections (SSIs) remain a significant challenge, impacting patient recovery and healthcare costs.
- Despite existing prevention programs, SSIs persist as a common complication in surgical patients.
- Class IV (dirty) wounds present unique challenges for primary closure and infection prevention.
Purpose of the Study:
- To describe and report outcomes of a modified primary closure technique for Class IV surgical wounds.
- To evaluate the efficacy of subcutaneous wound wicks with stapled skin closure in preventing SSIs.
- To assess the safety and cost-effectiveness of this novel wound management strategy.
Main Methods:
- A prospective case series of 14 consecutive patients with Class IV laparotomy wounds treated between 2011 and 2015.
- All patients underwent laparotomy for conditions including acute abdomen or intra-abdominal infection.
- The modified primary closure involved subcutaneous wound wicks and stapled skin closure, with slow wick advancement over 7 days.
Main Results:
- No 30-day mortalities or readmissions were recorded in the study cohort.
- Zero instances of superficial or deep surgical site infections or wound dehiscence were observed.
- Only one patient required additional wound packing, highlighting the technique's minimal need for secondary interventions.
Conclusions:
- The modified primary closure technique, incorporating subcutaneous wound wicks and stapled skin closure, is effective for managing Class IV surgical wounds.
- This method demonstrates efficiency, cost-effectiveness, and a high safety profile, preventing SSIs and other complications.
- The technique offers a promising solution for reducing the burden of surgical site infections in high-risk wound classifications.
