Comparison of Surgical Site Infection Between Conventional and Negative Pressure Wound Therapy-Assisted Delayed Primary Skin Closure in Grossly Contaminated Emergency Abdominal Surgeries: A Randomized Controlled Trial

Introduction: This study aimed to compare surgical site infection (SSI) rate between conventional and negative pressure wound therapy (NPWT)-assisted delayed primary skin closure in grossly contaminated emergency abdominal surgeries. Methods: Patients aged more than 18 years undergoing emergency laparotomy for features of peritonitis with class 4 wound were included in the study. They were randomized into conventional arm and NPWT arm after confirming the diagnosis intraoperatively. The sheath was closed and skin laid open after completion of surgery. Regular dressing done with normal saline and gauge in control arm, while NPWT dressing was applied in test arm. The wound was assessed for feasibility of delayed primary closure on post operative day (POD) 5. Patients were followed-up until POD-30 for the assessment of primary endpoint, ie SSI. Postoperative wound complication and length of hospital stay were also evaluated. Results: A total of 86 patients were recruited (43 in each group). Final analysis was done on 81 patients as there were five mortalities within study period and they were excluded. The rate of SSI (10% in NPWT arm vs 37.5% in conventional arm, p = 0.004) was significantly lower in NPWT arm. The rate of seroma formation, wound dehiscence, and average length of hospital stay was also significantly lower in NPWT arm. Conclusion: The application of NPWT assisted delayed primary closure of skin shows significant reduction in the rate of SSI in class IV abdominal wounds in patients undergoing emergency abdominal surgeries, where the risk of SSI is significantly high.