Factors influencing outcome in delayed primary closure of contaminated abdominal wounds: a prospective analysis of 181 consecutive XXXX .

@entity1 @entity6177 @entity262 @entity281 @entity9974 @entity1320 @entity130
Delayed primary closure ( @entity9974 ) is an accepted method in the management of contaminated abdominal wounds. Clinical factors predicting its success have not been studied. Over a 14-year period 181 @entity1 presenting to a single surgeon with Class IV abdominal wounds were managed by a standardized protocol. Initial saline gauze packing was left undisturbed until the wound was visually inspected on postoperative day 3. Clean wounds were closed using SteriStrips. Visible purulence was managed by dressing changes. There were 103 males and 78 females with an average age of 48.5 years (range, 11-92 years). @entity9974 was performed on 144 @entity1 of whom four (2.8%) developed wound @entity281 . The factors associated with the development of wound pus before @entity9974 in the remaining @entity1 were: requirement for mechanical ventilation for more than 72 hours, presence of severe pre-existing @entity262 , and @entity130 . Other diagnoses, length and type of incision, and presence of shock had no effect on outcome. An @entity6177 developed in 11 @entity1 with early wound purulence versus none in those undergoing @entity9974 (P < 0.001). @entity9974 is a safe wound management technique that can be effectively applied in the large majority of @entity1 with dirty abdominal wounds. The appearance of wound purulence before @entity9974 is a harbinger that identifies those @entity1 at risk for late @entity1320 .
