CONTAMINATED WOUNDS - THE EFFECT OF INITIAL MANAGEMENT ON OUTCOME

Delayed primary closure has been advocated as the optimal method of ma nagement 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 f ound 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 a ggregate wound infection rate of 27 per cent (Class III-29%; Class IV- 24%). Only one (3%) of the wounds managed by delayed primary closure d eveloped an infection. If infection did not occur, there was no differ ence in the length of stay between patients managed with primary closu re and delayed primary closure, However, there was a significantly lon ger length of stay in the primary closure group if infection occurred. Benefit risk analysis of the patients with contaminated wounds confir med that in this clinical setting, delayed primary closure remains the optimal method of management for the wound.