***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background Closure of ileostomy is considered a contaminated operation . The infection rate of the stoma wound is ≥30 % . Several ileostomy – closure techniques intended to reduce the high rate of infection have been described in the literature . Among them , delayed primary closure of the stoma wound is a commonly used method that was reported to reduce the infection rate according to several retrospective studies . We therefore conducted the first prospect i ve r and omized trial comparing primary with delayed primary closure of a stoma wound . Methods During 2003 , 40 patients were admitted to our ward for closure of ileostomy .  The ileostomies were taken down by the same team using the same surgical technique except for the technique of wound closure . We r and omly divided the patients into two groups . In Group 1 ( n = 20 ) , the wound was left open for delayed primary closure and not closed until postoperative day 4 . In Group 2 , the wound was primarily closed at the end of the procedure . Results The total wound infection rate was relatively low ( 15 % ) . Infection occurred more frequently ( 4 cases , 20 % ) in Group 1 than in Group 2 ( 2 cases , 10 % ) . The length of hospital stay was similar for both groups . Conclusions In this first prospect i ve comparison of two techniques during ileostomy take down , primary closure unexpectedly produced less wound infection than delayed primary closure Background : It is still a matter of debate whether delayed primary closure ( DPC ) of contaminated abdominal incisions reduces surgical site infections compared with a primary closure ( PC ) . The aim of this study was to determine the optimal method of wound closure for patients with perforated appendicitis . Methods : A total of 70 patients with perforated appendicitis were included . They were r and omized to have their surgical incisions ( skin and subcutaneous tissue ) either PC or left open with Betadine‐soaked gauze packing for DPC on the fifth postoperative day or later if the wound conditions were inappropriate for closure . A wound was considered infected if pus discharged from the incision site . The main outcome measures were the incidence of wound infection and the length of hospital stay ( LOS ) . Results : In the entire series , wound infection developed after incision closure in 21.4 % of the patients . The PC group had a higher incidence of wound infection ( 38.9 % vs. 2.9 % , p < 0.001 ) and longer LOS ( 8.4 days vs. 6.3 days , p = 0.038 ) . Conclusion : Delayed primary closure is the optimal management strategy for perforated appendicitis wounds . It significantly reduces the wound infection rate and length of stay BACKGROUND AND PURPOSE It is still a matter of debate whether delayed primary closure ( DPC ) of dirty abdominal incisions reduces surgical site infections ( SSIs ) compared with primary closure ( PC ) . Our objective was to determine whether DPC of dirty abdominal incisions reduces SSIs . METHOD A controlled r and omized study was conducted at an academic tertiary care 1,500-bed university hospital in Western India involving 81 consecutive patients with dirty abdominal incisions . Only 77 patients ( DPC = 37 , PC = 40 ) were evaluable because of the deaths of four patients . A total of 52 patients had peptic or typhoid perforations , whereas the rest had appendicular perforations/abscesses , penetrating or blunt abdominal injuries with gastrointestinal perforation , or intra-peritoneal abscesses . Patients were r and omized to have their surgical incisions ( skin and subcutaneous tissue ) either closed primarily ( PC ) or left open with saline-soaked gauze dressings for DPC on the 3(rd ) postoperative day or later if the incision conditions were inappropriate for closure . The main outcome measure was the incidence of postoperative SSI . RESULTS In the entire series , SSI developed after incision closure in 23 % of the patients . Infections were significantly more common in the PC group ( 42.5 % vs. 2.7 % for DPC ; p = 0.0000375 ) . There also were significantly more cases of abdominal dehiscence in the PC group ( DPC 1 [ 2.7 % ] vs. PC 10 [ 25 % ] ; p = 0.005 ) . The mean complete incision healing ( CIH ) time and length of hospital stay ( LOS ) were longer after PC ( 18.52 days ) than DPC ( 13.86 days ) , result ing in a significant difference in the end point of healing and LOS ( p = 0.0207 ) . Short-term cosmetic results for PC incisions were significantly inferior to those for DPC ( p = 0.03349 ) . CONCLUSIONS Delayed primary closure is a sound incision management technique that should be utilized for dirty abdominal incisions . It significantly lowers the rate of superficial SSI as well as fascial dehiscence and reduces the mean CIH time and hospitalization . The short-term cosmetic appearance is superior A prospect i ve r and omized trial was performed on 122 patients with perforated or gangrenous appendicitis to determine whether delayed primary wound closure lowered morbidity from wound infection . The 54 per cent wound infection rate with delayed primary closure was significantly inferior to the 18 per cent infection rate for primary closure with topical ampicillin powder ( P = 0.0082 ) , but not significantly different from the 37 per cent infection rate for primary closure alone . Furthermore , patients disliked delayed primary closure  , their hospital stay was prolonged and 17 per cent of their wounds became contaminated with Staphylococci before being closed . Delayed primary wound closure  should not be used in treating perforated and gangrenous appendicitis wounds OBJECTIVE To compare the difference in the rate of surgical wound infection , patient 's convenience and length of hospital stay between Primary Closure and Delayed Primary Closure in cases of complicated appendicitis in adults . METHODS This r and omised control trial was conducted at the Combined Military Hospital , Kharian and Malir from June 5 , 2006 , to September 10 , 2009 . Patients > or = 15 years of both gender who underwent appendectomy through grid iron or Lanz incision and having complicated appendicitis were included . The 100 patients who were included in the study out of the initial size of 393 , were r and omised into two equal groups of 50 each ( Group A : Primary Closure ; Group B : Delayed Primary Closure ) using a computer-generated table . All the surgeries were done by the same surgeon and the operative steps and antibiotic coverage were st and ardised . The rate of surgical wound infection , patient 's convenience ( on visual analogue scale in mm ) and the length of hospital stay were recorded . Data was analysed using SPSS version 11 , and p value was calculated . RESULTS Demographic data , comorbids and medication of both the groups was comparable . There was no significant difference in rate of surgical wound infection ( p > 0.05 ) . The difference in patient 's convenience and length of hospital stay were significant ( p < 0.05 ) , showing superiority of Primary Closure over Delayed Primary Closure with no added morbidity/mortality . CONCLUSION Primary Closure in complicated appendicitis not only reduces the cost of treatment , but is also more convenient and satisfying for the patients , with no added risk of surgical wound infection Objective To determine the optimal method of wound closure for dirty abdominal wounds . Summary Background Data The rate of wound infection for dirty abdominal wounds is approximately 40 % , but the optimal method of wound closure remains controversial . Three r and omized studies comparing delayed primary closure ( DPC ) with primary closure ( PC ) have not conclusively shown any advantage of one method over the other in terms of wound infection . Methods Fifty-one patients with dirty abdominal wounds related to perforated appendicitis , other perforated viscus , traumatic injuries more than 4 hours old , or intraabdominal abscesses were enrolled . Patients were stratified by cause ( appendicitis vs. all other causes ) and prospect ively r and omized to one of two wound management strategies : E/DPC ( wound packed with saline-soaked gauze , evaluated 3 days after surgery for closure the next day if appropriate ) or PC . In the E/DPC group , wounds that were not pristine when examined on postoperative day 3 were not closed and daily dressing changes were instituted . Wounds were considered infected if purulence discharged from the wound , or possibly infected if signs of inflammation or a serous discharge developed . Results Two patients were withdrawn because they died less than 72 hours after surgery . The wound infection rate was greater in the PC group than in the E/DPC group . Lengths of hospital stay and hospital charges were similar between the two groups . Conclusion A strategy of DPC for appropriate dirty abdominal wounds 4 days after surgery produced a decreased wound infection rate compared with PC without increasing the length of stay or cost OBJECTIVE To compare the rate of wound infection of perforated appendicitis in children between primary wound closure and delayed primary wound closure .  STUDY DESIGN Prospect i ve clinical trial . MATERIAL AND METHOD Children diagnosed with perforated appendicitis between January 1999 and December 1999  received gentamicin and metronidazole pre- and post-operatively . Intra-abdominal fluid cultured and tested for sensitivity . The rate of wound infection , skin closure for patients were compared between primary wound closure and delayed primary wound closure . RESULTS Among 198 children diagnosed with appendicitis , 44 cases were perforated ( 22.22 % ) . Of these 44 cases , 8 cases had wound infection ( 18.18 % ) , 2 of 8 Infected cases ( 9.1 % ) were in the primary wound closure group , 6 of 8 ( 27.3 % ) were in the delayed primary wound closure group . CONCLUSION The rate of wound infection from perforated appendicitis in children is still high . Primary wound closure has a significantly lower rate of wound infection compared with delayed primary wound closure In a 3-year period , 63 consecutive patients with advanced perforated ( n=53 ) and gangrenous ( n=10 ) appendicitis were allocated to undergo either immediate wound closure or delayed primary wound closure after emergency appendectomy . The incidence of wound infection between delayed primary wound closure and immediate wound closure was similar ( 24.0 % and 21.1 % , respectively ) . The duration for complete healing of infected wounds was slightly shorter in the group undergoing delayed primary wound closure ( mean + /- SD , 24.3 + /- 9.2 days ) than in the group undergoing immediate wound closure ( mean + /- SD , 32.6 + /- 16.5 days ) , but the difference was not significant . However , healing of noninfected wounds was significantly prolonged in the group undergoing delayed primary wound closure ( mean + /- SD , 19.3 + /- 10.1 days ) compared with the group undergoing immediate wound closure ( mean + /- SD , 7.0 + /- 0 days ) . The latter had been shown to associate with more nonseptic wound complications and therefore required longer rehabilitation . Our study showed that delayed primary closure did not offer additional advantage over immediate closure in the treatment of wounds associated with advanced appendicitis in children 
    Output:
    
Our evidence suggested there might be no advantage of DPC over PC in reducing SSI in complicated appendicitis .