Time to Surgical Closure of Complex Infectious Wounds: A Single-center Retrospective Cohort Study

Abstract

Introduction. Surgical management of NSTIs can result in complex wounds, and closure of these wounds is often difficult or complicated. Although surgical factors influencing mortality and LOS have been well described, little is known about patient, wound, and surgical factors associated with time to closure. Objective. The purpose of this study is to identify patient, wound, and surgical factors that may influence time to closure of NSTIs. Materials and Methods. The records of patients who presented to a tertiary care center over an 11-year period (2007–2017) with an NSTI requiring surgical closure were retrospectively reviewed. Results. Forty-seven patients met the inclusion criteria. The average time to closure was 31.1 days, with an average of 4.8 procedures. Most patients were middle aged (mean, 50.3 years; range, 20–81 years), immunocompetent, and nondiabetic upon admission. Closure was achieved mainly with autograft. The percent TBSA was described in 19 cases (40%). There was no association between substance use (alcohol, smoking, or other), anticoagulant medication use, or medical comorbidities and time to closure. On multivariable analysis, flap closure (P =.02) and increased number of surgical procedures (P =.003)—the latter reflecting the need for an increased number of debridements—were associated with increased time to closure. Conclusions. The data in this study suggest that use of local flaps for wound closure and increased number of surgical procedures (particularly debridements) may be predictors of time to closure in patients with an NSTI.