Delayed primary closure versus primary closure for wound management in perforated appendicitis: a prospective randomized controlled trial.

BACKGROUND It is still a matter of debate whether delayed primary closure (DPC) of contaminated abdominal incisions reduces surgical site infections compared with a primary closure (PC). The aim of this study was to determine the optimal method of wound closure for patients with perforated appendicitis. METHODS A total of 70 patients with perforated appendicitis were included. They were randomized to have their surgical incisions (skin and subcutaneous tissue) either PC or left open with Betadine-soaked gauze packing for DPC on the fifth postoperative day or later if the wound conditions were inappropriate for closure. A wound was considered infected if pus discharged from the incision site. The main outcome measures were the incidence of wound infection and the length of hospital stay (LOS). RESULTS In the entire series, wound infection developed after incision closure in 21.4% of the patients. The PC group had a higher incidence of wound infection (38.9% vs. 2.9%, p<0.001) and longer LOS (8.4 days vs. 6.3 days, p=0.038). CONCLUSION Delayed primary closure is the optimal management strategy for perforated appendicitis wounds. It significantly reduces the wound infection rate and length of stay.