Comparative Study of Primary Closure versus Delayed Primary Closure of Skin in Contaminated and Dirty Abdominal Wounds / Incision

Introduction: Surgical or operative site infection is one of the most common operative complications occurring in upto 30-40% of those patients undergoing abdominal surgery, depending on the level of contamination. Surgical site infection (SSI) and associated complications can double the length of hospital stay and thereby increase the costs of health care. Primary closure of wound is the commonly practiced method. However, some surgeons prefer delayed primary closure (DPC) technique. The focus of the study is to establish the fact that delayed primary closure leads to reduction in SSI and its related complications by a significant number than primary closure. The scope of the study extends to all abdominal procedures which are pre-operatively or intra-operatively found to be contaminated or infected. Aims and objectives: To compare the frequency of surgical site infections and other complications associated with wound infection and to determine whether Delayed primary closure (DPC) of skin in contaminated and dirty wounds/Abdominal incisions reduces the rate of surgical site infections as compared to Primary closure. Patients and methods: A Prospective Comparative study on a total of 72 patients admitted and planned for Emergency abdominal surgeries in the Department of Surgery, Mahatma Gandhi Hospital from 1st December 2018 to 30st June 2020 were included in the study with a pre-set inclusion and exclusion criteria. The patients were randomised into two groups-Group A (DPC) and Group B (PC). Allocation of patients to various groups was done on a random basis. Patients in Group A underwent delayed primary closure (DPC) where skin and subcutaneous tissue were left open with saline/providone iodine soaked gauze dressings. Closure of skin was done on post-operative day 5 or even later depending upon the incision?s condition. Patients in Group B underwent Primary closure (PC) where skin and subcutaneous tissue were closed with Ethilon 2/0 mattress sutures. Results: Wound infection with Groups by Pearson?s chi-squared test were 2=8.025, p=0.005less than0.01 which shows highly statistical significant association between Wound infection and Groups. Stitch abscess with Groups by Pearson?s chi-squared test were 2=5.675, p=0.035less than0.05 which shows statistical significant association between Stitch abscess and Groups. Wound dehiscence with Groups by Pearson?s chi-squared test were 2=6.222, p=0.028less than0.05 which shows statistical significant association between Wound dehiscence and Groups. Conclusion: By our study, we concluded that delayed primary closure is an effective method of reducing surgical site infections along with its associated complications like stitch abscess, stitch sinus, wound dehiscence and subsequent Incisional hernias.