Smilanich R P, Bonnet I, Kirkpatrick J R
Department of Surgery, Washington Hospital Center, Washington, D.C. 20010-2975, USA.
Am Surg. 1995 May;61(5):427-30.
Delayed primary closure has been advocated as the optimal method of management in the presence of wound contamination. The present study was performed to determine whether surgeons have accepted this standard. A total of 918 surgical wounds were evaluated and classified according to the level of contamination and type of wound management used. We found that 150 patients had a Class III or Class IV contaminated wound; however, only 21 per cent were treated with delayed primary closure. The 118 patients treated with primary closure and antibiotics had an aggregate wound infection rate of 27 per cent (Class III-29%; Class IV-24%). Only one (3%) of the wounds managed by delayed primary closure developed an infection. If infection did not occur, there was no difference in the length of stay between patients managed with primary closure and delayed primary closure. However, there was a significantly longer length of stay in the primary closure group if infection occurred. Benefit risk analysis of the patients with contaminated wounds confirmed that in this clinical setting, delayed primary closure remains the optimal method of management for the wound.
对于存在伤口污染的情况，延期一期缝合已被视为最佳处理方法。本研究旨在确定外科医生是否已接受这一标准。根据伤口污染程度和所采用的伤口处理类型，共对918例手术伤口进行了评估和分类。我们发现，150例患者存在Ⅲ类或Ⅳ类污染伤口；然而，仅有21%的患者接受了延期一期缝合治疗。接受一期缝合并使用抗生素治疗的118例患者，总体伤口感染率为27%（Ⅲ类伤口为29%；Ⅳ类伤口为24%）。采用延期一期缝合处理的伤口中，仅1例（3%）发生了感染。如果未发生感染，接受一期缝合和延期一期缝合治疗的患者住院时间并无差异。然而，如果发生感染，一期缝合组的住院时间则显著延长。对污染伤口患者进行的利弊分析证实，在这种临床情况下，延期一期缝合仍是伤口处理的最佳方法。
