Aggressive Surgical Debridement With Primary Closure for Surgical Wound Dehiscence: A Retrospective Cohort Study Comparing Healing Outcomes to Negative Pressure Wound Therapy.

Surgical wound dehiscence (SWD) is a serious postoperative complication associated with significant morbidity, mortality and healthcare costs. Traditional management, including negative pressure wound therapy (NPWT), relies on secondary intention healing, which can be prolonged. This study evaluates a strategy of aggressive surgical debridement followed by primary wound closure (ASDC) to convert surgical wounds to primary intention healing. In this retrospective cohort study, we compared outcomes between ASDC and NPWT in 106 SWD patients (2013-2023). The ASDC group (n = 62) underwent radical debridement and early closure, while the NPWT group (n = 44) received standard debridement and NPWT until complete epithelialization. Healing time, hospital stay, costs and complications were analyzed. Non-parametric tests and Kaplan-Meier analysis with log-rank test were used for comparisons. The ASDC group had a significantly shorter median healing time (21.0 vs. 47.5 days, p < 0.001) and median hospital stay (14.0 vs. 19.0 days, p = 0.004). Total treatment costs were lower in the ASDC group (36,897 ± 14,188 vs. 57,457 ± 28,791 RMB, p < 0.001). Complication rates (infection, bleeding, reoperation) showed no statistically significant difference between groups. Sensitivity analysis of patients treated during the overlapping protocol period (2015-2017) yielded consistent results. In this retrospective analysis, ASDC was associated with significantly accelerated wound healing, shorter hospitalization and lower costs compared to NPWT for SWD management, without an increase in detected complications. This suggests ASDC may be an efficient alternative strategy, though prospective studies are needed to control for selection bias and confirm these findings.