Deferred Primary Closure Versus Immediate Closure in Contaminated Wounds
Keywords:
delayed primary closure; contaminated wound; postoperative complications; surgical wound; surgical site infectionAbstract
Introduction: Surgical site infection is a highly significant problem, ranging from 2% in clean procedures to 40% in contaminated surgeries.
Objective: To evaluate the association between deferred primary closure and the incidence of surgical site infection.
Methods: A non-randomized, quasi-experimental study conducted from September 2021 to September 2025 at the Martín Chang Puga Hospital in Nuevitas, Camagüey, involving 66 adult patients who underwent emergency surgery for contaminated surgical sites, divided into two groups based on the parity of their year of birth: Group 1—deferred primary closure; Group 2—immediate closure. Deferred closure consisted of leaving the skin and subcutaneous tissue open with unknotted nylon sutures, daily dressings with 10% povidone-iodine, and definitive closure on the fifth day, provided there were no signs of infection. Demographic variables, operative diagnosis, surgical site infection, complications related to closure, and clinical course were recorded.
Results: There were no significant differences in age, sex, or operative diagnosis (complicated appendicitis). The incidence of surgical site infection was lower in Group 1 (6.1% vs. 21.2%). Closure-related complications were less frequent in Group 1: seroma (6.1% vs. 18.2%), hematoma (3.0% vs. 12.1%), and dehiscence (0% vs. 9.1%). The outcome was favorable in 31 patients (93.9%) vs. 26 patients (78.8%) in Group 1.
Conclusions: Delayed primary closure of the surgical wound is an effective strategy in contaminated surgeries.
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