Use of antibiotic prophylaxis in penetrating abdominal trauma.

Information concerning the efficacy of prophylactic antibiotics in patients sustaining penetrating abdominal trauma is limited. Duration of such therapy is also uncertain. Thus a prospective, randomized, double-blind study was performed at Grady Memorial and City of Memphis Hospitals. A total of 360 patients sustaining penetrating abdominal trauma were randomized to one of three groups: group 1, cefotaxime perioperatively only; group 2, cefotaxime perioperatively plus postoperative doses every six hours for 24 hours; and group 3, cefazolin perioperatively plus postoperative doses every six hours for 24 hours. Postoperative infection of the incision or peritoneal cavity occurred in 20 (17%) of the patients in group 1, 13 (10%) in group 2, and 11 (9%) in group 3. Differences were not statistically significant. The occurrence of higher infection rates in group 1 may be explained by the greater number of patients sustaining shotgun wounds and rectal injuries. This study lends support to the practice of discontinuing antibiotic therapy on termination of the operative procedure. Cefotaxime has been found to be a reliable, effective agent for prophylaxis against infection in patients who have sustained penetrating abdominal trauma.

Abdominal incisions: transverse vs vertical placement and continuous vs interrupted closure.

A previous retrospective review of 2,006 emergency laparotomies had suggested that anesthesia and operative times could be reduced by using a continuous stitch closure for all layers of the incision. A prospective, randomized study was then implemented through use of odd/even digits in the last and next-to-last digits in the hospital number. Of 551 patients subjected to laparotomy because of abdominal trauma, no intraperitoneal injury was found in 212. There was no statistically significant difference in time expended or complications (wound or other, including pulmonary) on contrasting transverse (101) with vertical (111) incisions, or on comparing continuous (104) and interrupted (108) closure, with the exception of an average 26 minutes in time saved by a continuous suture (P = .02). Analysis of these same factors in 339 patients with trauma found at laparotomy could document no statistically significant difference. Such data support the use of a running suture for closure of the abdominal wall as a practical method to save anesthesia and operating time without increased risk of developing a wound or other postoperative complication.