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Article
Post-appendectomy Infected Wounds and Ideal Management A Retrospective Study

Author: Mahmoud M. Al-Mukhtar محمود محمد المختار
Journal: Al-Qadisiyah Medical Journal مجلة القادسية الطبية ISSN: 18170153 Year: 2014 Volume: 10 Issue: 17 Pages: 118-124
Publisher: Al-Qadisiyah University جامعة القادسية

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Abstract

Background :Abdominal operations are traditionally classified into elective and emergency procedures both of which may be complicated by postoperative wound infections. Although postoperative wound infection is usually infrequent following elective procedures, it is an anticipated and acceptable complication of emergency surgeries as these operations are usually of a contaminated nature with no standard preoperative preparation associated with an urge to operate.Objectives :This study tries to compare the results of a two adopted regimes to manage post-appendectomy wound infections in regard to the significance of using parenteral antibiotics.Methods : This study had evaluated (108) patients with clinical postoperatively wound infections over a period of (3) years in Al-Hilla General Teaching Hospital. All cases with normal appendices and those on preoperative antibiotics therapy for any reason had been excluded from the study. Two treatment regimes had been evaluated : Regime (A) consisting of changing antiseptic wound dressings only while Regime (B) consisted of changing antiseptic wound dressings combined with parenteral administration of intravenous metronidazole (500) mg thrice daily with intravenous cefotaxime (1000) mg twice daily. The study group had been allocated to a randomized single-blind trial to assess the outcomes. Patients were followed–up to an average of (50) days.Results :There is a beneficial effects of adopting Regime (B) in the management of infected wounds following perforated appendectomies in terms of reducing the number of dressings change and the period of inpatients hospitalization . This was not the case with infected wounds following non-perforated appendectomies.Conclusion : According to the literature reviewed, in order to prevent or reduce the rate of post-appendectomy infected wounds it is recommended to use preoperative prophylactic antibiotics which is not a routine in our practice.Wound irrigation with antiseptics may be beneficial in prevention of wound infection following complicated appendectomy. Regime (B) of treatment should be reserved for infected wounds following complicated appendectomy.

خلفية البحث : تصنف العمليات الجراحية البطنية تقليديا الى عمليات أختيارية و أخرى طارئة و كلاهمها من الممكن أن يتبع بعدوى جروح العمليات . وفيما تعتبر عدوى الجروح في العمليات الأختيارية من غير الشائعة فأنها من المضاعفات المتوقعة و المقبولةفي جراحة الطواري كونها عادة ما تكون ملوثة و تجرى بدون تحضير قياسي لما قبل العملية مع وجود دافع للتداخل الجراحيالسريع .الأهداف : تهدف هذه الدراسة الى مقارنة نتائج أستخدام نظامين لعلاج عدوى جروح أستئصال الزائدة و تقييم الفائدة المرجوة من أستخدام المضادات الحياتية حقنا بالوريد .الطريقة : قيمت هذه الدراسة (108) مصابا بعدوى جروح أستئصال الزائدة على مدى ثلاث سنوات في مستشفى الحلة التعليمي العام . تم أستثناء كل الحالات التي كانت فيها الزائدة غير ملتهبة أو كان المريض يتعاطى المضادات الحياتية ما قبل العملية لأي سبب كان . كان النظام العلاجي ( أ ) مكونا من تبديل ضماد الجروح بضمادات مطهرة و حسب الحالة بينما كان النظام العلاجي ( ب )مكونا من تبديل ضماد الجروح بضمادات مطهرة و حسب الحالة مع أضافة المضاد الحياتي المترونيدازول (500 ) ملغم وريديا ثلاث مرات يوميا مع السيفوتاكسيم (1000) ملغم وريديا مرتين يوميا . تم توزيع المرضى بصورة عشوائية في تجربة مفردة التعمية على النظاميين العلاجيين ( أ ) و ( ب ) لغرض تقييم النتائج. تم متابعة المرضى لمدة معدلها (50) يوما .النتائج : كانت هناك نتائج مفيدة بأستخدام النظام العلاجي (ب) في علاج عدوى جروح عمليات أستئصال الزائدة المثقوبة و ذلك بدلالة تناقص في عدد الضمادات المستخدمة وفي فترة رقود أقل في المستشفى . لم تكن النتائج كذلك عند معالجة عدوى جروح عمليات أستئصال الزائدة غير المثقوبة .الأستناج :أستنادا الى مراجعة الدراسات و التقارير السابقة التي تناولت نفس الموضوع فأنه من المستحسن أستخدام علاج المضاد الحياتي الأحترازي قبل أجراء العملية و لكن هذا لا يتم العمل به في ممارستنا الجراحية . أن غسل الجروح بالمطهرات بعد أستئصال الزائدة المثقوبة مباشرة مفيد لمنع حدوث عدوى الجروح . يوصى بأن النظام العلاجي (ب ) يجب أن يستخدم لعلاج عدوى جروح أستئصال الزائدة المثقوبة تحديدا.


Article
COMPARATIVE STUDY BETWEEN INTERRUPTED MATTRESS AND CONTINUOUS SUBCUTICULAR SKIN CLOSURE IN REGARDING POST-APPENDECTOMY WOUND INFECTION

Author: Ahmed Abdul-Hadi Safar
Journal: Basrah Journal of Surgery مجلة البصرة الجراحية ISSN: 16833589 / ONLINE 2409501X Year: 2016 Volume: 22 Issue: 1 Pages: 17-24
Publisher: Basrah University جامعة البصرة

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Abstract

Abstract Historically, potentially infected surgical wounds, like in acute appendicitis, were recommended to be closed by interrupted skin suturing. However, this method of skin closure can leave a marked scar at the closure site after healing of the wound. On the other hand, there are no enough data about the potential risk increment in wound infection following skin closure by continuous subcuticular approach. This is a prospective study aimed to compare the results of skin closure using interrupted mattress and subcuticular continuous approaches following appendectomy, in terms of postoperative wound infection rates. One hundred and ten (110) patients with acute appendicitis admitted to Al-Sadir Teaching Hospital in the period between January 2013 and February 2014 were chosen for the study. The patients were divided into two groups. In one group, (58) patients, the appendectomy wound was closed by interrupted mattress, and patients in the other group, (52) patients, underwent continuous subcuticular skin closure. All patients were followed up for two days postoperatively in the hospital and seven days as outpatient follow-up for signs and symptoms of wound infection. By assessing the effect of risk factors on the rate of post-appendectomy wound infection, the following results were obtained: Effect of gender on postoperative infection: Males: 8/59 (13.6%), Females 6/51 (11.8%), P value: 0.079. So the association between gender and rate of infection was not significant. Effect of smoking on postoperative infection: Smokers: 4/24 (16.7%), Non-smokers: 10/86 (11.6%), P value: 0.429. So the association between smoking and the rate of infection was not significant. Effect of family history of previous appendectomy on postoperative infection: Positive family history: 7/34 (20.6%), Negative family history: 7/76 (10.1%), P value: 2.738. So the association between family history and the rate of infection was not significant. Effect of history of previous abdominal operations on postoperative infection: Positive history: 1/7 (16.7%), Negative history: 13/103 (12.6%), P value: 0.066. Thus the association between history of previous abdominal operations and the rate of post-appendectomy wound infection was not significant.In interrupted mattress skin closure group, 7/58 (12%) patients developed signs and symptoms of wound infection, whereas in the continuous subcuticular skin closure group, 7/52 (13.4%) patients developed wound infection. In conclusion, there is no significant difference in the risk of wound infection between skin closure by interrupted mattress and continuous subcuticular approaches.

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