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

Delayed primary closure (DPC) 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 patients 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). DPC was performed on 144 patients of whom four (2.8%) developed wound infections. The factors associated with the development of wound pus before DPC in the remaining patients were: requirement for mechanical ventilation for more than 72 hours, presence of severe pre-existing systemic disease, and trauma. Other diagnoses, length and type of incision, and presence of shock had no effect on outcome. An intra-abdominal abscess developed in 11 patients with early wound purulence versus none in those undergoing DPC (P < 0.001). DPC is a safe wound management technique that can be effectively applied in the large majority of patients with dirty abdominal wounds. The appearance of wound purulence before DPC is a harbinger that identifies those patients at risk for late intra-abdominal infections.