Published: 2019-07-25

Evaluation of partial wound closure in perforated appendicitis

Muhammed H. Jaafar Al-Sa'adi, Ali Laibi Zamil


Background: Perforated appendicitis is a serious complication of acute appendicitis that usually occurs due to over delay in presentation, diagnosis, and surgical treatment. Wound infection is one of the important sequelae of perforated appendicitis. Method of the wound closure in perforated appendicitis is a critical factor that affects the incidence of wound infection and there is continuing controversy about the best method.

Methods: 362 patients with a diagnosis of acute appendicitis were enrolled in a prospective randomized study that extended over three years. The intraoperative gross pathological state of the appendix was recorded as either negative or uncomplicated or perforated appendicitis. The relationship between the wound infection with each one of the three methods of wound closure (primary closure, open wound with delayed primary closure and partial wound closure) had been reported. The hospital stays were recorded for each method.

Results: 18.78% of appendectomy was appendicitis negative, 62.98% uncomplicated appendicitis and 18.23% with perforated appendicitis. In the perforated appendicitis cases, Primary wound closure was used in 36.36%, open method and delay primary closure in 18.18% and partial wound closure in 45.45%. The wound infection rates were 37.5%, 16.66% and 13.33% in primary wound closure, open wound with delayed primary closure and partial wound closure respectively. Length of hospital stays were 7 days, 8 days and 4 days respectively.

Conclusions: partial wound closure is superior to other methods of wound closure, which are primary wound closure and open wound with delayed primary wound closure.


Closure, Perforated appendicitis, Wound

Full Text:



Leung AK, Sigalet DL. Acute abdominal pain in children. Am Fam Physician. 2003;67(11):2321-8.

Hendrickson M, Naparst TR. Abdominal surgical emergencies in the elderly. Emerg Medi Clin North Am. 2003;21(4):937-69.

Fitz RH. Perforating Inflammation of The Vermiform Appendix; With Special Reference To Its Early Diagnosis And Treatment. 1. Am J Med Sci (1827-1924). 1886;1(184):321.

O'Connell PR, Williams NS, McCaskie A. The vermiform appendix; Bailey & Love's Short In: Practice of Surgery. The Collector’s Ed. 2018:1299.

Saar S, Talving P, Laos J, Põdramägi T, Sokirjanski M, Lustenberger T, et al. Delay between onset of symptoms and surgery in acute appendicitis increases perioperative morbidity: a prospective study. World J Surg. 2016;40(6):1308-14.

Chatwiriyacharoen W. Surgical wound infection post surgery in perforated appendicitis in children. J Med Assoc Thai. Chotmaihet thangphaet. 2002;85(5):572-6.

McGreal GT, Joy A, Manning B, Kelly JL, O’Donnell JA, William W, et al. Antiseptic wick: does it reduce the incidence of wound infection following appendectomy? World J Surg. 2002;26(5):631-4.

Martone W, Jarvis WR, Edwards JR, Culver DH, Haley RW. Bennett JV et al. Incidence and nature of endemic and epidemic nosocomial infections. Hospital infections. 1998:461-76.

National Nosocomial Infections Surveillance (NNIS) System. NNIS report, data summary from October 1986-April 1996, issued May 1996. A report from the NNIS System. Am J Infect Control. 1996;24(5):380-88.

Martone WJ, Nichols RL. Recognition, prevention, surveillance, and management of surgical site infections: Introduction to the problem and symposium overview. University of Chicago Press. 2001;13(Suppl2):S67-8.

Cruse PJ, Foord R. The epidemiology of wound infection: a 10-year prospective study of 62,939 wounds. Surgical Clinics of North America. 1980;60(1):27-40.

Margenthaler JA, Longo WE, Virgo KS, Johnson FE, Oprian CA, Henderson WG, et al. Risk factors for adverse outcomes after the surgical treatment of appendicitis in adults. Ann Surg. 2003;238(1):59.

Bohnen JM, Solomkin JS, Dellinger EP, Bjornson HS, Page CP. Guidelines for clinical care: anti-infective agents for intra-abdominal infection: a Surgical Infection Society policy statement. Arch Surg. 1992;127(1):83-9.

Herych I, Vashchuk V. Antibiotic prophylaxis in abdominal surgery. Klin Khir. 2006(3):20-2.

Sganga G. New perspectives in antibiotic prophylaxis for intra-abdominal surgery. J Hospital Infec. 2002;50(Suppl 1):S17-21.

Chiang RA, Chen SL, Tsai YC, Bair MJ. Comparison of primary wound closure versus open wound management in perforated appendicitis. J Formos Med Assoc. 2006;105(10):791-5.

Schein M, Marshall JC. Source control: a guide to the management of surgical infections In: Springer Science & Business Media. 2013:3.

Grosfeld JL, Solit RW. Prevention of wound infection in perforated appendicitis: experience with delayed primary wound closure. Ann Surg. 1968;168(5):891.

Henry MC, Moss RL. Primary versus delayed wound closure in complicated appendicitis: an international systematic review and meta-analysis. Pediatr Surg Int. 2005;21(8):625-30.

Cohn SM, Giannotti G, Ong AW, Varela JE, Shatz DV, McKenney MG et al. Prospective randomized trial of two wound management strategies for dirty abdominal wounds. Ann Surg. 2001;233(3):409.

Siribumrungwong B, Noorit P, Wilasrusmee C, Thakkinstian A. A systematic review and meta-analysis of randomised controlled trials of delayed primary wound closure in contaminated abdominal wounds. World J Emerg Surg. 2014;9(1):49.

Hepburn H. Delayed primary suture of wounds. Br Med J. 1919;1(3033):181.

Kirby JP, Mazuski JE. Prevention of surgical site infection. Surg Clin North Am. 2009;89(2):365-89.

Duttaroy DD, Jitendra J, Duttaroy B, Bansal U, Dhameja P, Patel G, et al. Management strategy for dirty abdominal incisions: primary or delayed primary closure? A randomized trial. Surg Infec. 2009;10(2):129-36.

Verrier ED, Bossart KJ, Heer FW. Reduction of infection rates in abdominal incisions by delayed wound closure techniques. Am J Surg. 1979;138(1):22-8.

Burnweit C, Bilik R, Shandling B. Primary closure of contaminated wounds in perforated appendicitis. J pediat Surg. 1991;26(12):1362-5.

Rucinski J, Fabian T, Panagopoulos G, Schein M, Wise L. Gangrenous and perforated appendicitis: a meta-analytic study of 2532 patients indicates that the incision should be closed primarily. Surgery. 2000;127(2):136-41.

Pettigrew RA. Delayed primary wound closure in gangrenous and perforated appendicitis. Br J Surg. 1981;68(9):635-8.

Tsang TM, Tam PK, Saing H. Delayed primary wound closure using skin tapes for advanced appendicitis in children: a prospective, controlled study. Arch Surg. 1992;127(4):451-3.

Serour F, Efrati Y, Klin B, Barr J, Gorenstein A, Vinograd I. Subcuticular skin closure as a standard approach to emergency appendectomy in children: prospective clinical trial. World J Surg. 1996;20(1):38-42.

Elmore JR, Dibbins AW, Curci MR. The treatment of complicated appendicitis in children: What is the gold standard?. Arch Surg. 1987;122(4):424-7.

Schwartz MZ, Tapper D, Solenberger RI. Management of perforated appendicitis in children. The controversy continues. Ann Surg. 1983;197(4):407.

Siribumrungwong B, Srikuea K, Thakkinstian A. Comparison of superficial surgical site infection between delayed primary and primary wound closures in ruptured appendicitis. Asian J Surg. 2014;37(3):120-4.