Delayed Primary Wound Closure versus Primary Wound Closure - A Dilemma in Contaminated Abdominal Surgeries

INTRODUCTION: Majority of emergency surgeries are performed through midline laparotomy wound; however when it comes to the closure of midline wound surgeons deploy various options. Technique of Primary closure of the wound is simple and cost effective as no other procedure is required. However, some surgeons favor technique of delayed primary closure because of decreased frequency of wound infection. OBJECTIVE: The purpose of our study was comparison of primary wound closure technique and delayed primary wound closure techniques with respect to rate of wound infection and other complication associated with wound infection like wound dehiscence, stitch sinuses, incisional hernias. PATIENT AND METHOD: This comparative study carried out among fifty patients who underwent midline exploratory laparotomy for perforated abdominal viscera in Surgical Unit I of Civil hospital Karachi. Patients were divided into two groups. The sample size was calculated using significance level of 0.05 and power of 80% for difference in wound infection rates in the two groups. All patients of both genders; in each group; who underwent emergency laparotomy having identical pathologies were taken in account. Patients with co-morbid were excluded. In the study group (Group A), primary closure technique was used and in group B, delayed primary closure was utilized. All patients were followed for post-operative wound complications. RESULTS: In our study male to female ratio was 2: 1 and the mean age was 33 +/- 10 years. Wound healed normally with no signs of infection in 23(46%) out of 50 patients. The overall infection rate was considerably low in delayed closure group (40%) when compared to the primary closure group which was 68% (p<0.05). There was significant decrease in other complication related to wound infection like stitch abscess formation and wound dehiscence in delayed closure group (p-<0.05). CONCLUSION: Our results demonstrate that the delayed primary closure technique is a better technique with low frequency of wound infection and other related complications when compared with primary wound closure technique.