Delayed primary wound closure in gangrenous and perforated appendicitis

Area of Science:

• Surgical outcomes
• Infectious disease control

Background:

• Appendicitis, particularly perforated or gangrenous cases, presents a risk of surgical site infections.
• Wound management strategies aim to minimize postoperative morbidity.

Purpose of the Study:

• To evaluate the efficacy of delayed primary wound closure versus primary closure in reducing wound infection rates in patients with perforated or gangrenous appendicitis.

Main Methods:

• A prospective randomized trial involving 122 patients.
• Comparison of three groups: delayed primary closure, primary closure with topical ampicillin powder, and primary closure alone.

Main Results:

• Delayed primary closure resulted in a significantly higher wound infection rate (54%) compared to primary closure with ampicillin (18%).
• No significant difference in infection rates between delayed primary closure and primary closure alone (37%).
• Delayed primary closure led to prolonged hospital stays and increased Staphylococcus contamination.

Conclusions:

• Delayed primary wound closure is not recommended for managing perforated or gangrenous appendicitis wounds.
• Primary closure, especially with topical ampicillin, appears more effective in reducing surgical site infections and improving patient outcomes.