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Outcomes of Radical Wound Excision in Infected Pfannenstiel Wounds after Failed Debridement
Riaz Ahmad Afridi1, Zahra Tauqeer1, Farnaz Zahoor2
1Department of Plastic Surgery, Lady Reading Hospital, Peshawar, Pakistan.
Objective:
To evaluate the outcomes of radical excision of infected Pfannenstiel (gynaecological and obstetric) surgical wounds.
Study Design:
A descriptive case study. Place and Duration of the Study: Department of Obstetrics and Gynaecology, Lady Reading Hospital, Peshawar, Pakistan, from December 2023 to June 2024.
Methodology:
A total of 80 female patients with culture-confirmed infected lower abdominal surgical wounds following obstetric or gynaecological procedures, who had failed debridement (three or more), were included in the study. Patients' primary outcomes were assessed in terms of whether the wound healed after a single radical excision and the number of days spent in the hospital after the procedure. The mean difference between the duration of stay before and after radical excision was determined by using the Paired T-test. Secondary outcomes were complications at long-term follow-up at one and three months.
Results:
The mean age was 38.70 ± 16.66 years. The prior surgical procedures included elective gynaecological (46.7%) and emergency C-section (30%). The primary outcome of wound healing was observed in 86.7% (26 patients) within 2 weeks, with 13% healed by the end of the third week. Prior hospital stay was 10.793 ± 8.36 days. The mean difference between the duration of stay before and after radical excision was statistically significant, with a mean difference of 8.1 days (p <0.001, 95% CI: -5.55 to -11.97). The mean difference in scar size between the preoperative and postoperative measurements was 10.367 cm, representing a statistically significant decrease (p <0.001, 95% CI: -9.124 cm to -11.609 cm). Complications were observed in four patients, with three having partial wound dehiscence and one patient leading to delayed wound healing (>21days).
Conclusion:
Radical wound excision offers a one-step streamlined procedure, enabling swift resumption of regular activities and minimising hospitalisation duration. Additionally, it alleviates the strain on both patients and healthcare systems.
Key Words:
Radical excision, Surgical site infection, Wound debridement.
