Skin Tape Research Articles

Saving the failing wound

When suturing thin skin under significant tension one runs a high risk of somewhat delayed wound healing and increased scarring (1,2). When superficial infection is superimposed upon this problem, the surgeon often stands helplessly by as the dissolving subcutaneous sutures gradually give way and the wound progressively separates. Systemic and topical antibiotics are very often of marginal benefit in arresting the whole process of separation, which seems to be more mechanical, with the inflamed thin skin opening as the remaining dissolving sutures become point-loaded and serially fail. The use of steri-strips or some other static tape is not particularly beneficial. The separated wound edges cannot be reapproximated even with serial reapplication of tape. The edge of the tape exposed to exudate from the wound often loosens and the adhesive tends to cause shear forces and blistering at the intact skin adhesive margin (3). At this point, traditional rescue efforts are usually abandoned and dressings are begun to clean the wound to facilitate closure by secondary intervention. The author has used an ingenious new dynamic skin tape called SutureSafe from Canica Design Inc, Canada, in dealing with problems of this sort with considerable benefit, as is shown in the accompanying photo sequence. This dynamic tape, when put on early, even in thin skin under some tension, relieves the forces that would tend to progressively open the wound. If separation begins to occur the wound is protected, such that progressive suture failure will not occur resulting in a complete dehiscence. In fact, a wound that is beginning to dehisce can actually be pulled back together by the dynamic forces of the DynaStretch Tape. This adhesive micropore tape is not reinforced as are steri-strips, and stretches with the compliant skin thereby avoiding blistering. The central silicone elastomer produces relentless gentle dynamic closure forces. One can see the wound through the transparent silicone elastomer to discern any underlying infectious process. Topical antibiotics can be used in the wound. In fact, we have used thin packing on occasion. This is removed as the wound closes. The tape is easily applied, and typically lasts from five to seven days. When used over a period of three or four weeks it salvages and allows primary wound healing even in the face of superficial infection.

Revolutionary Advances in the Management of Traumatic Wounds in the Emergency Department During the Last 40 Years: Part II

During the last four decades, our research team has devised advances in wound repair that are highlighted in Part II of this collective review. There are several different methods to provide an accurate and secure approximation of the skin edges-sutures, tapes, staples, and tissue adhesives. Ideally, the selection of the wound closure technique will be based on the biologic interaction of the materials employed, tissue configuration, and biomechanical properties of the trauma wound. Selection of the appropriate wound dressing is another important consideration in the management of the trauma wound. On the basis of the comprehensive research and clinical studies, we have individualized the wound closure techniques for traumatic wounds so that healing can be achieved with more aesthetically pleasing scars.

Rapid analysis of tetracaine for a tape stripping pharmacokinetic study using short‐end capillary electrophoresis

A rapid and simple short-end (reverse) capillary zone electrophoresis method was developed and validated for the separation and quantification of tetracaine in skin using tape samples. The separation was performed in a 485 mm (400 mm to window) x 50 microm internal diameter fused silica capillary using a background electrolyte of phosphoric acid-Tris pH2.5 at -25 kV. The extraction of tetracaine from tape samples was achieved using methanol diluted to 50% with water before injection. Procaine was the internal standard. The migration times for procaine and tetracaine were 1.25 and 1.36 min, respectively. The limit of quantification for tetracaine was 50 microg, with a signal-to-noise ratio greater than 10. The calibration curve was linear from 50 to 1200 microg with r(2) greater than 0.99. The CV for both within- and between-assay imprecision and the percentage inaccuracy for the quality control samples including lower and upper limits of quantitation were <12.1% and <11%, respectively. The absolute mean recovery of tetracaine was >97%. The accuracy and selectivity of this method allowed the rapid measurement of tetracaine in tape samples obtained from a skin tape stripping study of local anaesthetics in healthy subjects.

Incidence of Blood Stream Infection Influenced by Dressing and Clinical Skin Care in a Patient with Neutropenia

Purpose For cancer-bearing patients, especially for patients with hematological malignancies, blood access is a ‘lifeline’ during chemotherapy, in three senses: administration of chemotherapy for the cancer treatment, intravenous supply of nutrients when a patient's oral intake is decreased, and injection of many agents for supportive care including antibiotics and G-CSF. For these purposes, we usually use a central venous catheter (CVC) at the subclavian portion. Dressing and skin care of the CVC are critical factors influencing the incidence of catheter-related blood stream infection (CRBSI). To clarify the association between preventative procedures and CRBSI rates, we summarize the effectiveness of annually instituted interventions for the prevention of CRBSI and present the result of surveillance of catheter infection in our hospital for a decade, from 1998 to the present.Method This is a prospective cohort study analyzing patients seen in our hospital for the treatment of cancer and predicting neutropenia by observation of catheter infection. All of the patients underwent CVC (Microneedle Seldinger Kit, Safe Guide II, Argyle) insertion with a subclavian approach except for patients with subclavian venous troubles such as embolism or occlusion. Each year for the first five years, we instituted new precautions for preventing CRBSI. Those interventions wereintroducing low-irritant skin tape from 1999,applying the maximal barrier precaution (MBP) procedure from 2000,applying closed injection-line system (Interlink system; Japan Beckton Dickinson, Tokyo, Japan) from 2001,once-a-week dressing using adherent transparent film (Tegaderm; Sumitomo 3M, Tokyo, Japan) from 2002, andusage of one pair of glove in each procedure for an individual patient from 2003.More than 2 sets (One set means blood samples from peripheral blood and CVC) of blood culture samples were drawn when a patient's body temperature (axillary) increased to more than 38.0 ºC. Multiple detection of the same isolate in the same individual during a series of febrile episode was considered as one infectious event. Bacteremia was defined as the isolation of at least one pathogen from at least one blood sample. BSI was defined as the recognition of a pathogen from one or more blood cultures that is not related to an infection at another site. CRBSI was defined as bacteremia in a patient with CVC with at least one positive pathogen obtained from a blood culture, and no apparent source for the BSI. We evaluated the duration of CVC insertion, episodes of febrile event, isolated bacteria and bacteremia.Results A total of 55,469 catheter-days were observed. The incidence of CRBSI per one thousand catheter-days was 8.08±2.76 before our interventions (before 1998), 4.18±2.59 after the low-irritant skin tape, 2.84±1.26 after the MBP procedure, 2.18±1.69 after the closed injection-line system, 2.84±2.17 after once-a-week dressing, and 2.53±2.63 after the individual-gloves intervention. After the introduction of MBP, the incidence of CRBSI was significantly decreased from before the start of interventions (P<0.001). Though the subsequent interventions (closed line system, once-a-week dressing and individual-gloves intervention) did not apparently influence the incidence of CRBSI, they were believed to keep the incidence of BSI low.Conclusion Applying MBP and low-irritant tape was significantly effective for decreasing the incidence of CRBSI. A concomitant use of MBP and valid taping might be most influential for preventing CRBSI.

Traction-Assisted Dermatogenesis by Serial Intermittent Skin Tape Application

The use of both tissue expanders and skin-stretching devices is commonplace in reconstructive surgery. The authors describe a noninvasive technique of tissue expansion. This article describes a prospective study in which 26 consecutive patients consisting of eight male patients and 18 female patients were recruited for expanding the skin by the authors' devised technique of intermittent serial traction Micropore taping of skin at weekly intervals. Once the skin was expanded, the scar revision was performed in one or two stages by excision and flap advancement. The age range of the patients was 8 to 48 years. The anatomical regions that underwent scar revision were scalp (n = 6), face (n = 9), upper limb (n = 6), and lower limb (n = 9). The size of the scars to be resurfaced ranged from 35 x 50 mm on the temple to 280 x 130 mm on the scalp. The average follow-up after surgical correction was 11 months. The number of taping sessions ranged from two to 15, with an average of 6.9. Fourteen patients had successfully completed the surgical management, and four patients are in the midst of treatment. Four patients defaulted on treatment, and in four patients, the expansion failed to progress. Illustrative examples of some of the cases are described. Traction-assisted dermatogenesis is an additional method of tissue expansion that is easy and cost effective for reconstruction.

The lymph vessel network in mouse skin visualised with antibodies against the hyaluronan receptor LYVE-1

Langerhans cells and dermal dendritic cells migrate to the draining lymph nodes through dermal lymphatic vessels. They do so in the steady-state and under inflammatory conditions. Peripheral T cell tolerance or T cell priming, respectively, are the consequences of migration. The nature of dendritic cell-containing vessels was mostly defined by electron microscopy or by their lack of blood endothelial markers. Selective markers for murine lymph endothelium were hitherto rare or not available. Here, we utilised recently developed antibodies against the murine hyaluronan receptor, LYVE-1, to study the lymph vessel network in mouse skin in more detail. In hairless skin from the ears, lymph vessels were spread out in a horizontal plane. They formed anastomoses, and they possessed frequent blind endings that were occasionally open. Lymph vessels were wider than blood vessels, which were identified by their strong CD31 expression. In body wall skin LYVE-1 reactive vessels did not extend laterally but they dived straight down into the deeper dermis. There, they are connected to each other and formed a network similar to ear skin. The number and width of lymph vessels did not grossly change upon inflammatory stimuli such as skin explant culture or tape stripping. There were also no marked changes in caliber in response to the TLR 7/8 ligand Imiquimod. Double-labelling experiments of cultured skin showed that most of the strongly cell surface MHC II-expressing (i.e. activated) dendritic cells were confined to the lymph vessels. Langerin/CD207 + cells within this population appeared later than dermal dendritic cells, i.e. langerin-negative cells. Comparable results were obtained after stimulating the skin in vivo with the TLR 7/8 ligand Imiquimod or by tape stripping. In untreated skin (i.e. steady state) a few MHC II + and Langerin/CD207 + cells, presumably migrating skin dendritic cells including epidermal Langerhans cells, were consistently observed within the lymph vessels. The novel antibody reagents may serve as important tools to further study the dendritic cell traffic in the skin under physiological conditions as well as in conditions of adoptive dendritic cell transfer in immunotherapy.

Treatment of Tobacco Dependence

Cigarette smoking continues to cause substantial death and disability, but more than 1 in 5 adults smoke despite the desire among most smokers to stop and the availability of effective treatments. A systematic process to identify all smokers is crucial. Because tobacco dependence is characterized by relapses and remissions, clinicians should be ready to engage smokers and reengage relapsed smokers with options for new medication strategies and additional counseling resources.

Validation and application of capillary electrophoresis for the analysis of lidocaine in a skin tape stripping study

A fast and simple capillary zone electrophoresis method was developed and validated for the determination of lidocaine in skin using tape samples. Separation was performed in a 350 mm (265 mm to window) x 50 microm i.d. fused silica capillary using a background electrolyte of phosphoric acid-Tris pH 2.5. The extraction of lidocaine from tape samples was achieved using methanol, which was diluted to 50% with water before injection. Procaine was the internal standard. The migration times for procaine and lidocaine were 2.9 and 3.2 min, respectively. The limit of quantification for lidocaine was 50 microg, with signal to noise ratio greater than 10. The calibration curve was linear from 50 to 1000 microg with r(2) greater than 0.99. The CV for both within- and between-assay imprecision and the percentage of inaccuracy for the quality control samples including lower and upper limits of quantitation were <or=2% and <or=14%, respectively. The absolute recovery of lidocaine was >97%. The accuracy and selectivity of this method allowed the measurement of lidocaine in tape samples obtained from a skin tape stripping study of local anesthetics in healthy subjects.

Symmetrical alopecia, scaling and hepatitis in a rabbit

A 5-year-old rabbit with inappetence, symmetrical alopecia and skin lesions was examined. No mites or Malassezia were found in skin scrapings and tape impressions and dermatophyte culture was negative. Trial therapy with ivermectin did not reduce skin lesion severity, and euthanasia was performed because of anorexia after 1 month. Histopathology of the skin showed hyperkeratosis, lymphocytic exocytosis, cell-poor interface dermatitis (lymphocytic infiltration and apoptotic cells in basal layer of epidermis), absence of sebaceous glands and lymphocytic mural folliculitis comparable to sebaceous adenitis and thymoma-associated exfoliative dermatitis previously described in rabbits. The liver exhibited an interface hepatitis, comparable to autoimmune hepatitis in man. The occurrence of morphological similarities to exfoliative dermatitis and sebaceous adenitis in rabbits, in association with an autoimmune hepatitis, has not been described before.

‘Needle Adhesiolysis’ Prior to Port Insertion During Laparoscopy

TECHNIQUE We constructed a novel traction device by combining a standard Futuro-type wrist splint with traction weights (Futuro brand; Beiersdorf, Hamburg, Germany). The metallic strut of the wrist splint provides a firm base onto which the weights are attached using strong fabric adhesive tape (Fig. 1). The device allows traction weights to be added or removed whilst in use. Traction does not rely on direct contact between skin and adhesive tape thus minimising the risk of skin damage through shearing force. If scapular manipulation is required to complete the shoulder reduction. a single operator can still perform this.

Heavy Water Labeling of Keratin as a Non-Invasive Biomarker of Skin Turnover In Vivo in Rodents and Humans

Measurement of skin turnover has been problematic in humans. Heavy water (2H2O) labeling has recently been developed as a safe, simple method to study in vivo kinetics of many biosynthetic processes, including DNA and protein synthesis. Here, we apply this approach to the measurement of 2H incorporation into skin keratin and show close agreement between keratin and keratinocyte turnover data in the epidermis of rodents. Elevated turnover rates of both keratin and keratinocytes were observed in the epidermis of the flaky skin mouse, although topical treatments effective in human psoriasis had no effect on either turnover rate in these mice. In humans, keratin turnover was monitored non-invasively by serial tape stripping during and after 2H2O labeling. Kinetic data were consistent with previous estimates of epidermal turnover, with a lag time of 18 days before label appeared at the skin surface and a transit time of 4-5 weeks. Variability in skin keratin turnover rates was present among healthy individuals. In summary, 2H2O labeling of skin keratin represents a non-invasive approach for assessing skin turnover dynamics in pre-clinical models and in human subjects.

Cubosome Dispersions as Delivery Systems for Percutaneous Administration of Indomethacin

The present study concerns the production and characterization of monooleine (MO) dispersions as drug delivery systems for indomethacin, taken as model anti-inflammatory drug. Dispersions were produced by emulsification and homogenization of MO and poloxamer in water. Morphology and dimensional distribution of the disperse phase have been characterized by cryo-transmission electron microscopy and photon correlation spectroscopy, respectively. X-ray diffraction has been performed to determine the structural organization of the disperse phase. Sedimentation field flow fractionation (SdFFF) has been performed to investigate drug distribution in the dispersion. An in vitro diffusion study was conducted by Franz cell associated to stratum corneum epidermis membrane on cubosome dispersions viscosized by carbomer. In vivo studies based on skin reflectance spectrophotometry and tape stripping were performed to better investigate the performance of cubosome as indomethacin delivery system. Microscopy studies showed the coexistence of vesicles and cubosomes. X-ray diffraction revealed the presence of a bicontinuous cubic phase of spatial symmetry Im3m (Q229). SdFFF demonstrated that no free drug was present in the dispersion. Indomethacin incorporated in viscosized MO dispersions exhibited a lower flux with respect to the analogous formulation containing the free drug in the aqueous phase and to the control formulation based on carbomer gel. Reflectance spectroscopy demonstrated that indomethacin incorporated into MO dispersions can be released in a prolonged fashion. Tape-stripping experiments corroborated this finding. MO dispersions can be proposed as nanoparticulate systems able to control the percutaneous absorption of indomethacin.

Wound Healing and Scar Formation on the Skin of the Chest Wall and the Lower Leg After Cardiac Bypass Surgery

Introduction: Many patients receiving heart surgery have extensive operation scars on the skin surface of the chest wall and lower leg. In some cases there are long lasting open wounds in the lower leg after vein harvesting. Some patients complain of pain and itching and we can recognize hypertrophic or extensive scars, which we have to treat.Case and result: We treated 16 patients (11 men and 5 women) ranging in age from 47 to 86. They were receiving many drugs such as anticoagulants, thus wound healing was delayed. In these cases, we choose not to resect tissue but apply ointment to remove necrotic tissue, and prepare good granulation tissue for smooth epithelization. Then, we employ prophylactic measures against hypertrophic scar formation such as tape containing steroid, silicon gel sheets and skin tapes as well oral medicine (toranilast) for the same purpose. Because of they have had to continuously take many oral medicines, these patients often do not want to take additional oral medicine. This is one point of difference in the treatment of heart surgery patients and patients with other types of wounds.

Optimal closure method of five-millimeter trocar sites

Background Although many surgeons use absorbable sutures for skin closure of 5-mm trocar sites, effective alternative materials exist. We compared 5-mm trocar site closures using a vicryl suture (VS), cyanoacrylate tissue adhesive (CTA), or skin tape (ST). Methods Patients rated wound pain and appearance at 1 and 6 weeks after surgery. Seven surgeons masked to the closure method rated wound photographs at these time points using the Hollander wound evaluation scale. Logistic regression analysis was used to evaluate the ratings of each closure group. Results The 137 wounds of 48 patients undergoing laparoscopic procedures were randomized among three closure method groups. Patient demographics and procedure type were similar for all groups. Long closure times (>30 seconds) was significantly higher for VS compared with CTA and ST. Patients favored VS over ST and CTA at 1 week with respect to pain and wound appearance ( P = 0.04 and P = 0.02, respectively). They rated CTA closures more likely to have pain and poor wound appearance at 6 weeks ( P = 0.05 and P = 0.03, respectively). Surgeons rated VS less likely ( P = 0.02) and CTA more likely ( P = 0.003) to show moderate to severe scar formation. Vicryl suture was less likely to have wound separation and edge inversion ( P = 0.017 and P = 0.006, respectively). Cyanoacrylate tissue adhesive was more likely to yield step-off ( P = 0.03), contour irregularities ( P = 0.005), separation ( P = 0.004), excessive distortion ( P = 0.001), and edge inversion ( P = 0.03). Conclusions Although VS closure time of 5-mm trocar sites takes longer than CTA and ST, VS scar formation and comfort is superior to CTA and ST. Cyanoacrylate tissue adhesive yields poor results with respect to both wound healing and pain.

In vivo study of the physiological impact of stratum corneum sampling methods

Several methods have been developed to study in vivo the stratum corneum with minimal 'invasion'. Cyanoacrylate adhesives employed in skin surface biopsy (SSB) and tape stripping are commonly used techniques that can be applied to study the different layers of the epidermis or even to permeation studies. However, depending on the type of adhesive tape used and pressure applied, different information is gathered. The purpose of this study was to identify and compare the impact of both techniques in the normal skin physiology to further establish its potential usefulness and limitations. Alterations were focused on basic structural related properties, such as epidermal barrier function (assessed by transepidermal water loss evaporimetry) and flow related changes (by laser Doppler velocimetry and colourimetry). Results indicate a more pronounced impact of SSB than that of tape stripping, attributable to the removal of a thicker layer of cells. The intertechnique correlation coefficients were good between transepidermal water loss and colourimetry, but poorer between these techniques and laser doppler flowmetry, which probably reflects the difficulties associated with this technique.

Histopathologic effects of cutaneous tape stripping in pigs.

The stratum corneum (SC) is the major barrier to topical absorption of medications. Skin tape stripping (TS) removes the stratum corneum, allowing more rapid absorption of drugs such as local anesthetics. Prior to evaluating TS in human clinical trials, this study was performed to evaluate its immediate and delayed histopathologic effects in swine. This was a prospective, interventional, longitudinal, experimental animal study using two isoflurane-anesthetized young swine. Cellophane tape was applied to the skin of clipped swine flanks and peeled away 10, 15, 20, 25, or 30 times. Each level of tape stripping was performed three times in each pig. Full-thickness biopsies were taken at 30 minutes and two weeks later for blinded histopathologic evaluation by a dermatopathologist using randomly ordered hematoxylin-and-eosin-stained tissue sections and conventional light microscopy. The absolute thickness of the cornified layer was measured and compared with normal (unstripped) cornified layer. Tape stripping up to 30 times produces thinning of the SC without detectable changes in the underlying epidermis and dermis at 30 minutes and 14 days post-stripping. The degree of thinning was proportional to the number of tape applications. Complete recovery of the cornified layer was noted at two weeks. There were no adverse effects, such as infection, scarring, or inflammatory cell infiltrates. Under the conditions studied, TS not only appears safe, but appears to produce no long-term sequelae.

Identification of pancreatic type I secreted phospholipase A2 in human epidermis and its determination by tape stripping.

Phospholipases A2 (PLA2) catalyse the release of fatty acids from the sn-2 position of phospholipids and have been suggested to play a key part in permeability barrier homeostasis. Using a sensitive and versatile fluorometric method, significant PLA2 activity has been detected in both human skin homogenates and tape strippings of stratum corneum. Based on various properties (resistance to heat and sulphuric acid treatment, neutral optimal pH, absolute requirement for millimolar calcium concentrations, inhibition by dithiothreitol and p-bromophenacyl bromide, and resistance to a trifluoromethyl ketone derivative of arachidonic acid, AACOCF3, a specific inhibitor of cytosolic PLA2), this enzyme was characterized as a secretory PLA2 (sPLA2). Immunohistochemistry revealed strong labelling of type I pancreatic sPLA2 at the stratum corneum-stratum granulosum junction, type II sPLA2 being undetectable. An increase in PLA2 activity in tape-stripped material from the deepest level of the stratum corneum was correlated with partial morphological disappearance of type I sPLA2 immunolabelling. Our data thus provide the first convincing evidence that pancreatic sPLA2 is significantly expressed in human epidermis, where it might participate in the accumulation of free fatty acids contributing to the permeability barrier. In addition, our method for determining PLA2 activity in easily available tape strippings should allow further clinical studies aimed to explore possible PLA2 abnormalities in various dermatoses.

Percutaneous Absorption of Salicylic Acid, Theophylline, 2,4-Dimethylamine, Diethyl Hexyl Phthalic Acid, andp-Aminobenzoic Acid in the Isolated Perfused Porcine Skin Flap Compared to Manin Vivo

Human risk assessment for topical exposure requires percutaneous absorption data to link environmental contamination to potential systemic dose. Human absorption data are not readily available, so absorption models are used.In vitrodiffusion systems are easy to use but have proved to be somewhat unreliable and are not validated to man. This study compares percutaneous absorption in the isolated perfused porcine skin flap (IPPSF) system with that in manin vivo.The study design utilized the same compounds and the same dose concentration and vehicle in both systems. Methodology for each system was that which is routinely used ineach system. The skin surface was not protected during the absorption dosing period. Percutaneous absorption values were, for man and the IPPSF system, respectively: salicylic acid (6.5 ± 5.0%; 7.5 ± 2.6%), theophylline (16.9 ± 11.3%; 11.8 ± 3.8%), 2,4-dimethylamine (1.1 ± 0.3%; 3.8 ± 0.6%), diethyl hexyl phthalic acid (1.8 ± 0.5%; 3.9 ± 2.4%), andp-aminobenzoic acid (11.5 ± 6.3%; 5.9 ± 3.7%) (correlation coefficient was 0.78;p< 0.04).The skin surface wash recovery postapplication was similar for salicylic acid in man (53.4 ± 6.3%) and the IPPSF system (48.2 ± 4.9%). With the other compounds the majority of surface chemical was recovered in the surface wash and skin tape strip in the IPPSF system. With man, other than salicylic acid, only a few percent applied dose was recovered with surface washing and tape stripping. Since the wash procedure was effective with pig skin, we can assume that these chemicals in man were lost to adsorption to any clothing or bedding with the volunteers. The absorption in man was not less than that in the IPPSF. Assuming the dose was lost in man, it seems plausible that whatever compound was to penetrate human skin in solvent vehicle did so in the period of time before the chemical was removed.The IPPSF system appears to be a good model for predicting percutaneous absorption relative to man. This study design should be used to validate other systems to humansin vivo.

Evaluation of a hydrocolloid dressing.

A hydrocolloid dressing was compared to adhesive skin tapes on children's postoperative wounds. A total of 170 children of varying ages were randomised in two parallel groups, in nine centres of plastic, thoracic, gastrointestinal, urogenital and orthopaedic surgery. Skin closure was satisfactory in both groups, with 76 (89.4%) healthy closures without dehiscence in the hydrocolloid group and 81(95.3%) in the control group; a relationship was found between partial closures/dehiscence and the type of surgical procedure. No product-related maceration, infection or adverse event was reported during the study and both groups showed very satisfactory cosmetic results.

Delayed Primary Wound Closure Using Skin Tapes for Advanced Appendicitis in Children

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.