Delayed Primary Closure in Managing Pediatric Abdominal Wound Infections
Main Article Content
Keywords
Delayed primary closure, pediatric abdominal wound infections, resource-limited settings, wound healing, complication rates
Abstract
Background: Abdominal wound infections are a common postoperative complication in pediatric patients, often requiring specialized care to minimize complications and promote healing. Delayed primary closure (DPC) is a widely recognized technique for managing infected or contaminated wounds, particularly in resource-limited settings.
Objective: This study was aimed to evaluate the outcomes of DPC in managing pediatric abdominal wound infections, focusing on healing time, complication rates, and hospital stay duration.
Methods: This prospective observational study was conducted for about 6 months from Nov, 2009 to April, 2010 in the Department of Paediatric Surgery, Khalifa Gulnawaz Teaching Hospital, Bannu Medical College, Bannu, Pakistan. One hundred fifty patients aged 0 to 12 years with abdominal wound infections treated by DPC were enrolled. Demographic information, specific clinical variables, procedural factors, and post-procedure complications and mortalities were recorded. The significance of associations was analysed by applying statistical tests; factors with P < 0.05 were assumed to be significant.
Results: Most patients who participated in the study were cured within 14 days; 53.3% healed within 7–14 days, while 33.3% healed within less than 7 days. There were remarks on complications in 20% of cases, with wound dehiscence attesting to 13.3% and re-infection in 6.7%. The hospital stay was mostly within 5–10 days (46.7%), while fewer cases required more days. Hypo and hyper nutrition in the contaminated sites and timely interventions affected the results (P < 0.05).
Conclusion: Delayed primary closure proved to be the most feasible and effective way of dealing with pediatric abdominal wound infections in LMICs. This technique helps heal wounds faster and has fewer complications, lowering hospitalisation rates. Based on the findings, the theory and its applicability to similar healthcare contexts can be generalized, focusing on infection control and early intervention.
Objective: This study was aimed to evaluate the outcomes of DPC in managing pediatric abdominal wound infections, focusing on healing time, complication rates, and hospital stay duration.
Methods: This prospective observational study was conducted for about 6 months from Nov, 2009 to April, 2010 in the Department of Paediatric Surgery, Khalifa Gulnawaz Teaching Hospital, Bannu Medical College, Bannu, Pakistan. One hundred fifty patients aged 0 to 12 years with abdominal wound infections treated by DPC were enrolled. Demographic information, specific clinical variables, procedural factors, and post-procedure complications and mortalities were recorded. The significance of associations was analysed by applying statistical tests; factors with P < 0.05 were assumed to be significant.
Results: Most patients who participated in the study were cured within 14 days; 53.3% healed within 7–14 days, while 33.3% healed within less than 7 days. There were remarks on complications in 20% of cases, with wound dehiscence attesting to 13.3% and re-infection in 6.7%. The hospital stay was mostly within 5–10 days (46.7%), while fewer cases required more days. Hypo and hyper nutrition in the contaminated sites and timely interventions affected the results (P < 0.05).
Conclusion: Delayed primary closure proved to be the most feasible and effective way of dealing with pediatric abdominal wound infections in LMICs. This technique helps heal wounds faster and has fewer complications, lowering hospitalisation rates. Based on the findings, the theory and its applicability to similar healthcare contexts can be generalized, focusing on infection control and early intervention.
References
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2. Lahat G, Tulchinsky H, Goldman G, Klauzner J, Rabau M. Wound infection after ileostomy closure: a prospective randomized study comparing primary vs. delayed primary closure techniques. Techniques in coloproctology. 2005;9:206-8.
3. Caniano DA, Ruth B, Teich S. Wound management with vacuum-assisted closure: experience in 51 pediatric patients. Journal of pediatric surgery. 2005;40(1):128-32.
4. Ekeh AP, McCarthy MC, Woods RJ, Walusimbi M, Saxe JM, Patterson LA. Delayed closure of ventral abdominal hernias after severe trauma. The American journal of surgery. 2006;191(3):391-5.
5. Waldhausen JH, Davies L. Pediatric postoperative abdominal wound dehiscence: transverse versus vertical incisions1. Journal of the American College of Surgeons. 2000;190(6):688-91.
6. Öztürk H, Önen A, Otçu S, Dokucu Aİ, Yağmur Y, Kaya M, et al. Diagnostic delay increases morbidity in children with gastrointestinal perforation from blunt abdominal trauma. Surgery today. 2003;33:178-82.
7. Ceydeli A, Rucinski J, Wise L. Finding the best abdominal closure: an evidence-based review of the literature. Current surgery. 2005;62(2):220-5.
8. Teich S, Caniano DA. Abdominal Wall Disruption. Reoperative pediatric surgery: Springer; 2008. p. 175-90.
9. Contractor D, Amling J, Brandoli C, Tosi LL. Negative pressure wound therapy with reticulated open cell foam in children: an overview. Journal of orthopaedic trauma. 2008;22:S167-S76.
10. Labler L, Zwingmann J, Mayer D, Stocker R, Trentz O, Keel M. VAC® Abdominal Dressing System: A Temporary Closure for Open Abdomen. European Journal of Trauma. 2005;31:488-94.
11. Abubakar A, Ofoegbu C. Factors affecting the outcome of emergency paediatric abdominal surgery. Nigerian Journal of Surgical Research. 2003;5(3):85-91.
12. Mooney III JF, Argenta LC, Marks MW, Morykwas MJ, DeFranzo AJ. Treatment of Soft Tissue Defects in Pediatric Patients Using the VAC (TM) System. Clinical Orthopaedics and Related Research (1976-2007). 2000;376:26-31.
13. Chatwiriyacharoen W. Surgical wound infection post-surgery in perforated appendicitis in children. Journal of the Medical Association of Thailand= Chotmaihet Thangphaet. 2002;85(5):572-6.
14. Chandramouli B, Srinivasan K, Jagdish S, Ananthakrishnan N. Morbidity and mortality of colostomy and its closure in children. Journal of pediatric surgery. 2004;39(4):596-9.
15. Neville HL, Lally KP, Cox Jr CS. Emergent abdominal decompression with patch abdominoplasty in the pediatric patient. Journal of pediatric surgery. 2000;35(5):705-8.
16. Jafri MA, Tevar AD, Lucia M, Thambi‐Pillai T, Karachristos A, Trumbull L, et al. Temporary silastic mesh closure for adult liver transplantation: a safe alternative for the difficult abdomen. Liver Transplantation. 2007;13(2):258-65.
2. Lahat G, Tulchinsky H, Goldman G, Klauzner J, Rabau M. Wound infection after ileostomy closure: a prospective randomized study comparing primary vs. delayed primary closure techniques. Techniques in coloproctology. 2005;9:206-8.
3. Caniano DA, Ruth B, Teich S. Wound management with vacuum-assisted closure: experience in 51 pediatric patients. Journal of pediatric surgery. 2005;40(1):128-32.
4. Ekeh AP, McCarthy MC, Woods RJ, Walusimbi M, Saxe JM, Patterson LA. Delayed closure of ventral abdominal hernias after severe trauma. The American journal of surgery. 2006;191(3):391-5.
5. Waldhausen JH, Davies L. Pediatric postoperative abdominal wound dehiscence: transverse versus vertical incisions1. Journal of the American College of Surgeons. 2000;190(6):688-91.
6. Öztürk H, Önen A, Otçu S, Dokucu Aİ, Yağmur Y, Kaya M, et al. Diagnostic delay increases morbidity in children with gastrointestinal perforation from blunt abdominal trauma. Surgery today. 2003;33:178-82.
7. Ceydeli A, Rucinski J, Wise L. Finding the best abdominal closure: an evidence-based review of the literature. Current surgery. 2005;62(2):220-5.
8. Teich S, Caniano DA. Abdominal Wall Disruption. Reoperative pediatric surgery: Springer; 2008. p. 175-90.
9. Contractor D, Amling J, Brandoli C, Tosi LL. Negative pressure wound therapy with reticulated open cell foam in children: an overview. Journal of orthopaedic trauma. 2008;22:S167-S76.
10. Labler L, Zwingmann J, Mayer D, Stocker R, Trentz O, Keel M. VAC® Abdominal Dressing System: A Temporary Closure for Open Abdomen. European Journal of Trauma. 2005;31:488-94.
11. Abubakar A, Ofoegbu C. Factors affecting the outcome of emergency paediatric abdominal surgery. Nigerian Journal of Surgical Research. 2003;5(3):85-91.
12. Mooney III JF, Argenta LC, Marks MW, Morykwas MJ, DeFranzo AJ. Treatment of Soft Tissue Defects in Pediatric Patients Using the VAC (TM) System. Clinical Orthopaedics and Related Research (1976-2007). 2000;376:26-31.
13. Chatwiriyacharoen W. Surgical wound infection post-surgery in perforated appendicitis in children. Journal of the Medical Association of Thailand= Chotmaihet Thangphaet. 2002;85(5):572-6.
14. Chandramouli B, Srinivasan K, Jagdish S, Ananthakrishnan N. Morbidity and mortality of colostomy and its closure in children. Journal of pediatric surgery. 2004;39(4):596-9.
15. Neville HL, Lally KP, Cox Jr CS. Emergent abdominal decompression with patch abdominoplasty in the pediatric patient. Journal of pediatric surgery. 2000;35(5):705-8.
16. Jafri MA, Tevar AD, Lucia M, Thambi‐Pillai T, Karachristos A, Trumbull L, et al. Temporary silastic mesh closure for adult liver transplantation: a safe alternative for the difficult abdomen. Liver Transplantation. 2007;13(2):258-65.
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May 18, 2010
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Dr. Muhammad Jehangir Khan. (2010). Delayed Primary Closure in Managing Pediatric Abdominal Wound Infections. Journal of Population Therapeutics and Clinical Pharmacology, 17(2), 336-342. https://doi.org/10.53555/rxw1dd74
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Author Biography
Dr. Muhammad Jehangir Khan
Assistant Professor, Department of Paediatric Surgery, Khalifa Gulnawaz Teaching Hospital, Bannu Medical College, Bannu, Pakistan.
How to Cite
Dr. Muhammad Jehangir Khan. (2010). Delayed Primary Closure in Managing Pediatric Abdominal Wound Infections. Journal of Population Therapeutics and Clinical Pharmacology, 17(2), 336-342. https://doi.org/10.53555/rxw1dd74