Cosmetic results and patient satisfaction with secondary wound healing after abdominal surgery.

Postoperative surgical wound infection remains a risk after contaminated abdominal surgery. 66 years ago Wilkie wrote “In cases with perforation and peritonitis, infection of the abdominal wound may be an important factor in determining a fatal issue. Open treatment of the wound is therefore advisable”. 1 This treatment is still a matter of debate although, in addition to preoperative antibiotic prophylaxis, it can reduce the wound infection rate to virtually nil. 2,3 It is the expected inferior cosmetic result that is considered its main disadvantage. 4 We did a prospective study to evaluate open treatment. Over 18 months, all patients who had open-wound management after contaminated abdominal surgery were compared with matched controls having had a similar operation with primary skin closure. Matching was by sex, age, race, body mass index, history of diabetes, and use of corticosteroids. Open wound management was given when severe bacterial contamination was encountered (class IV as defined by the National Research Council 5 ) or in case of moderate contamination (class III) with other predisposing factors for wound infection such as obesity or a difficult operation. Scars were evaluated at 3 months, 1 year, and 5 years. Width, discolouration, and persisting suture marks were recorded. The patients’ judgment and that of a panel of three plastic surgeons were recorded on a 1 (ugly) to 5 (excellent) scale. The plastic surgeons’ assessments were from standard photographs of each scar. Inter-observer variability between the plastic surgeons was tested by analysis. Comparisons between the three surgeons was done in three cross-tables. values were approximately 0·55. Incisions that ran parallel to relaxed skin-tension lines, and those that did not were evaluated separately. 66 patients (33 pairs) after appendicectomy and 72 (36 pairs) after a median incision were evaluated. In each group one minor wound infection occurred during open wound management. 12 patients died during follow-up and eight were lost. The cosmetic results are given in the table. For the scars after appendicectomy, no cosmetic difference was seen after closed or open healing. After median laparotomy, the cosmetic results of open healing were inferior to those of closed healing when assessed by width of the scar and panel judgment; patient satisfaction, however, was better. We believe that our data on long-term cosmetic results of open wound healing after contaminated abdominal surgery are reassuring and support its more general use. 1 Wilkie DPD. Observations on mortality in acute appendicular disease.