Tertiary Wound Closure for High-Risk Patients Undergoing Gynecologic Abdominal Surgery

Objective: Surgical-site infections (SSIs) are associated with morbidity and cost for high-risk patients undergoing abdominal gynecologic surgery. Wound closure by secondary intention lowers the risk of SSI. However, this technique is associated with delayed wound closure, long-term health care access requirements, and significant cost. This pilot study described an alternative wound-closure technique (tertiary closure) aimed at improving wound morbidity. Materials and Methods: Patients with high-risk, class II, class III, or class IV abdominal wounds undergoing gynecologic surgery had tertiary-closure performed. Antimicrobial suture and silver-impregnated negative-pressure wound therapy devices were incorporated into this technique. Results: Twelve consecutive patients underwent tertiary closure during 2018-2019 successfully. All patients were assessed for at least 6 months postsurgery. All wounds have remained closed since postoperative day 4. No SSIs, wound seromas, or incisional hernias have occurred. The average cost of this procedure ranged from $400 USD to $800 USD. Conclusions: Tertiary closure of high-risk abdominal wounds during gynecologic surgery is safe and feasible. Tertiary closure may be associated with lower rates of SSIs, fewer readmissions, and lower costs, compared to secondary closure. A larger trial has been designed by the current authors, comparing outcomes of tertiary closure to other closure methods.