Inyang Akan W, Usang Usang E, Talabi Ademola O, Anyanwu Lofty-John C, Sowande Oludayo A, Adejuyigbe Olusanya
Department of Surgery, University of Calabar Teaching Hospital, Calabar, Cross River State, Nigeria.
Department of Surgery, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria.
Afr J Paediatr Surg. 2017 Oct-Dec;14(4):70-73. doi: 10.4103/ajps.AJPS_166_14.
The optimal management strategy for dirty abdominal wounds has yet to be determined, but studies indicate that delayed primary closure (DPC) may be a reliable method of reducing surgical site infection (SSI) rate in these wounds. In this study, of dirty laparotomy wounds following typhoid ileal perforation (TIP), the SSI rate, incidence of wound dehiscence, and length of hospital stay (LOS) are compared in wounds primarily closed to those closed in the delayed primary fashion.
The study was conducted over a 12-month period. Consecutive patients aged between 0 and 15 years with typhoid ileal perforation (TIP) were enrolled and prospectively randomized to test (DPC) group and control (PC) group. Data including age, sex, diagnosis, type of wound closure, SSI, wound dehiscence, time to wound healing, and LOS were obtained and analyzed using SPSS version 16.
Fifteen patients were recruited into DPC group while 19 patients were allocated to the PC group. The SSI rate was 80% in the DPC group compared to 63.2% in the PC group (P = 0.451). 17.6% of patients in the DPC group and 8.8% in the PC group had wound dehiscence, respectively (P = 0.139). The difference in LOS although longer in the DPC group was not statistically significant (DPC 23.47 ± 9.2, PC 17.68 ± 18.9, P = 0.123).
DPC did not reduce the incidence of SSI and wound dehiscence, nor shorten LOS compared to PC. Therefore, PC of dirty wounds appears safe for the pediatric population and should be advocated.
污染性腹部伤口的最佳管理策略尚未确定，但研究表明，延迟一期缝合（DPC）可能是降低此类伤口手术部位感染（SSI）率的可靠方法。在本研究中，对伤寒性回肠穿孔（TIP）后的污染性剖腹手术伤口，比较一期缝合伤口与延迟一期缝合伤口的SSI率、伤口裂开发生率和住院时间（LOS）。
本研究为期12个月。纳入年龄在0至15岁之间的连续性伤寒性回肠穿孔（TIP）患者，并前瞻性随机分为试验（DPC）组和对照（PC）组。获取包括年龄、性别、诊断、伤口缝合类型、SSI、伤口裂开、伤口愈合时间和LOS等数据，并使用SPSS 16版进行分析。
DPC组招募了15名患者，PC组分配了19名患者。DPC组的SSI率为80%，而PC组为63.2%（P = 0.451）。DPC组和PC组伤口裂开的患者分别为17.6%和8.8%（P = 0.139）。尽管DPC组的住院时间较长，但差异无统计学意义（DPC 23.47±9.2，PC 17.68±18.9，P = 0.123）。
与一期缝合相比，延迟一期缝合并未降低SSI和伤口裂开的发生率，也未缩短住院时间。因此，对于儿童群体，污染伤口的一期缝合似乎是安全的，应予以提倡。
