Wound management with vacuum assisted closure in surgical site infection after ankle surgery

Wound site infections increase costs, hospital stay, morbidity, and mortality. Techniques used for wounds management after laparotomy are primary, delayed primary, and vacuum-assisted closures. The objective of this study is to compare infection rates between those techniques in contaminated and dirty/ infected wounds. Eighty-one laparotomized patients with Class III or IV surgical wounds were enrolled in a three-arm randomized prospective study. Patients were allocated to each group with the software Research Randomizer® (Urbaniak, G. C, & Plous, S., Version 4.0). Presence of infection was determined by a certified board physician according to Centers for Disease Control's Criteria for Defining a Surgical Site Infection. Twenty-seven patients received primary closure, 29 delayed primary closure, and 25 vacuum-assisted closure, with no exclusions for analysis. Surgical site infection was present in 10 (37%) patients treated with primary closure, 5 (17%) with primary delayed closure, and 0 (0%) patients receiving vacuum-assisted closure. Statistical significance was found between infection rates of the vacuum-assisted group and the other two groups. No significant difference was found between the primary and primary delayed closure groups. The infection rate in contaminated/dirty-infected laparotomy wounds decreases from 37 and 17 per cent with a primary and delayed primary closures, respectively, to 0 per cent with vacuum-assisted systems.

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AN UPDATED GUIDELINES ON POST-OPERATIVE WOUND MANAGEMENT

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v5i11.2274 ◽

2021 ◽

Vol 5 (11) ◽

Author(s):

Sangita Santosh Nimbalkar ◽

Manish R. Malani

Keyword(s):

Surgical Site Infection ◽

Surgical Procedure ◽

Wound Management ◽

Site Infection ◽

Nice Guidelines ◽

Postoperative Wound ◽

Post Surgery ◽

Operative Care ◽

Study Results ◽

Group 1

Introduction: management and prevention of wounds after a surgical procedure, are important and debatable topics. Optimal adoption of guidelines for proper prevention and management of post-surgical wounds must be carried out by any surgeon or institute. Postoperative wound care is done by cleaning and dressing the wounds after the surgical procedure, preventing them from getting contaminated with the external surfaces or the microorganisms on the patient’s body. Surgical Site Infection (SSI) is the infection associated with healthcare in which the infection occurs in the wound after an invasive surgical procedure. A minimum of 5% of the patients who undergo surgical procedures will develop surgical site infections. This study draws the attention of the clinicians to a proper set of guidelines for post-operative care to minimize post-operative complications. Materials and Methods: this study is a Retrospective Cohort design. The study was considered 92 patients who had various types of surgery from during the period of 10 months. The patients who had intra-abdominal surgery are only included. The study divided 92 patients into 2 groups. In each group, 46 patients were assigned based on following NICE guidelines on postoperative wound management. Patients, for whom the NICE guidelines were followed properly at every aspect, were assigned to the first group (Group 1). Otherwise, the patients were assigned to the second group (Group 2). The study adopted a list comprising of NICE guidelines which are applicable to this study. The study assessment was done by observing the appearance of Surgical Site Infection among the patients, 3 to 7 days post-surgery. Results: it as found that 91.30% of the Group 1 patients showed significant improvement in terms of resolution while only 13.04% of the patients in improved significant without any surgical site infection (SSI). Conclusion: the study results show that the patients who were given post-operative care according to NICE guidelines had much lesser Surgical Site Infection (SSI) as compared to those who were not given post-operative care according to NICE guidelines. Keywords: surgical site infection, postoperative care, nice guidelines, wound management

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Does Revascularization Prior to Foot and Ankle Surgery Reduce the Incidence of Surgical Site Infection (SSI)?

Foot & Ankle International ◽

10.1177/1071100719859343 ◽

2019 ◽

Vol 40 (1_suppl) ◽

pp. 15S-16S

Author(s):

Nima Heidari ◽

Alexander Charalambous ◽

Iris Kwok ◽

Alexandros Vris ◽

Yueyang Li

Keyword(s):

Wound Healing ◽

Beneficial Effect ◽

Surgical Site Infection ◽

Elective Surgery ◽

Site Infection ◽

Foot And Ankle ◽

Peripheral Vascular ◽

Level Of Evidence ◽

Diabetic Foot Infection ◽

Ankle Surgery

Recommendation: Several studies support the effect of peripheral vascular disease (PVD) on wound healing and surgical site infection (SSI). Despite this, there have been no specific studies proving the beneficial effect of revascularization on SSI prior to operative intervention in the setting of traumatic or elective foot and ankle surgery. The majority of studies on revascularization are in the setting of diabetic foot infection or established ischemia. We recommend that in the presence of an inadequate vascularization in the foot and ankle, vascular optimization should be undertaken prior to elective surgery. Level of Evidence: Limited. Delegate Vote: Agree: 100%, Disagree: 0%, Abstain: 0% (Unanimous, Strongest Consensus)

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Topically Applied Vancomycin Powder Reduces the Rate of Surgical Site Infection in Diabetic Patients Undergoing Foot and Ankle Surgery

Fuß & Sprunggelenk ◽

10.1016/j.fuspru.2016.03.011 ◽

2016 ◽

Vol 14 (2) ◽

pp. 111-112

Keyword(s):

Surgical Site Infection ◽

Diabetic Patients ◽

Site Infection ◽

Foot And Ankle ◽

Ankle Surgery ◽

Vancomycin Powder

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The use of incisional vacuum-assisted closure system following one-stage incision suture combined with continuous irrigation to treat early deep surgical site infection after posterior lumbar fusion with instrumentation

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02588-y ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Hang Shi ◽

Lei Zhu ◽

Zan-Li Jiang ◽

Zhi-Hao Huang ◽

Xiao-Tao Wu

Keyword(s):

Back Pain ◽

Surgical Site Infection ◽

Lumbar Fusion ◽

Site Infection ◽

Vacuum Assisted Closure ◽

Continuous Irrigation ◽

Posterior Lumbar Fusion ◽

One Stage ◽

Deep Surgical Site Infection

Abstract Background Previous reports concerning deep surgical site infection (SSI) after posterior spinal instrumentation treated with vacuum-assisted closure (VAC) system indicated that most patients must suffer from a delayed incision suture. To date, there are no published reports about the application of incisional VAC following a one-stage incision suture in the treatment of spinal infections. The purpose of this study was to evaluate the feasibility and efficacy of using an incisional VAC system following a one-stage incision suture combined with continuous irrigation to treat early deep SSI after posterior lumbar fusion with instrumentation. Methods Twenty-one patients who were identified as early deep SSI after posterior lumbar fusion with instrumentation were treated by incisional VAC following a one-stage incision suture combined with continuous irrigation at our spine surgery center between January 2014 and March 2020. Detailed data from medical records were collected and analyzed, including age, gender, primary diagnosis, original operation, number of VAC dressing changes, duration of continuous irrigation, hospital stay, risk factors for infection, bacteria type, and laboratory data. Clinical efficacy was assessed using the pre- and postoperative visual analog scale (VAS) for back pain and Kirkaldy-Willis functional criteria by regular follow-up. Results All the patients were cured and retained implants with an average of 1.9 times of VAC dressing replacement, and an average of 10.2 days of continuous irrigation. There were significant differences between pre-operation and post-operation in ESR, CRP, and VAS score of back pain, respectively (P < 0.05). The satisfactory rate was 90.5% according to Kirkaldy-Willis functional criteria. One patient developed a back skin rash with itching around the wound because of long-time contact with the VAC dressing. There was no recurrent infection or other complications during follow-up. Conclusions Our preliminary results support that the treatment protocol is feasible and effective to treat early deep SSI following posterior lumbar fusion with instrumentation.

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Does Wound Management Technique Impact Surgical Site Infection in Open Emergency Colon Procedures?

The American Surgeon ◽

10.1177/0003134820982565 ◽

2020 ◽

pp. 000313482098256

Author(s):

Justin J. Turcotte ◽

Andrea Boord ◽

Lauren Antognoli ◽

J. Robert Klune ◽

Cristina B. Feather

Keyword(s):

Length Of Stay ◽

Surgical Site Infection ◽

Alternative Methods ◽

Wound Management ◽

Secondary Outcome ◽

Management Technique ◽

Site Infection ◽

Vac Therapy ◽

Significant Difference ◽

Care Surgery

Background Emergency open large bowel procedures have higher rates of intraoperative contamination and increased risk of surgical site infection (SSI) than elective colon surgeries. Several wound management strategies have been proposed, such as vacuum-assisted closure (VAC) therapy and delayed primary closure to improve results. The purpose of this study is to evaluate the relationship between wound management technique and SSI and other quality measures. Methods We performed a retrospective review of patients undergoing open emergency colon surgery from January 2017 to December 2018 by our acute care surgery service. The primary outcome measure was incidence of SSI. Secondary outcome measures included length of stay, reoperation, and 30-day readmission. Results A total of 118 patients were included in the study, with a mean age of 62.8 years and mean BMI of 28.8. Overall incidence of SSI was 19.5%. There was no significant difference in incidence of SSI, reoperation, or 30-day readmission when stratifying by wound management technique or procedure type after controlling for confounding variables. Notably, patients managed with VAC therapy had a statistically significant longer average length of stay and higher total postoperative antibiotic days (both P = .001) than other techniques. Discussion We conclude from our data that wound management technique does not seem to influence rate of SSI, but wound management may influence length of stay or antibiotic duration. These findings suggest that there may not be an advantage to alternative methods of wound management in this high-risk population. Further prospective evaluation should be performed to confirm these findings.

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A silver-based antimicrobial dressing for the prevention of surgical site infection - a pilot study

10.35279/jewma202011.07 ◽

2020 ◽

Vol 21 (Issue 1 Volume 21, 2020) ◽

pp. 41-48

Author(s):

Jan Stryja ◽

Daniel Riha ◽

Jerzy Szkatula

Keyword(s):

Pilot Study ◽

Surgical Site Infection ◽

Postoperative Complication ◽

Best Practice ◽

Case Series ◽

Perioperative Period ◽

Surgical Patients ◽

Wound Management ◽

Site Infection

Surgical site infection is a postoperative complication that affects many surgical patients worldwide. It has been estimated that up to 60% of SSIs are preventable and that their risk can be minimised by applying the best practice in the perioperative period. Proper wound management is one way of preventing the incidence of SSIs. This paper describes results of a descriptive case series focused on the usage of silver dressing on post-operative wounds.

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