Wound photography for evaluation of surgical site infection and wound healing after lower limb trauma

2021 ◽  
Vol 103-B (12) ◽  
pp. 1802-1808
Author(s):  
Julie Bruce ◽  
Ruth Knight ◽  
Nick Parsons ◽  
Ria Betteridge ◽  
Amy Verdon ◽  
...  
Keyword(s):  
Wound Healing ◽  
Surgical Site Infection ◽  
Clinical Assessment ◽  
Lower Limb ◽  
Open Fracture ◽  
Alternative Methods ◽  
Site Infection ◽  
Limb Fracture ◽  
Wound Photography ◽  
Level Of Agreement

Aims Deep surgical site infection (SSI) is common after lower limb fracture. We compared the diagnosis of deep SSI using alternative methods of data collection and examined the agreement of clinical photography and in-person clinical assessment by the Centers for Disease Control and Prevention (CDC) criteria after lower limb fracture surgery. Methods Data from two large, UK-based multicentre randomized controlled major trauma trials investigating SSI and wound healing after surgical repair of open lower limb fractures that could not be primarily closed (UK WOLLF), and surgical incisions for fractures that were primarily closed (UK WHiST), were examined. Trial interventions were standard wound care management and negative pressure wound therapy after initial surgical debridement. Wound outcomes were collected from 30 days to six weeks. We compared the level of agreement between wound photography and clinical assessment of CDC-defined SSI. We are also assessed the level of agreement between blinded independent assessors of the photographs. Results Rates of CDC-defined deep SSI were 7.6% (35/460) after open fracture and 6.3% (95/1519) after closed incisional repair. Photographs were obtained for 77% and 73% of WOLLF and WHiST cohorts respectively (all participants n = 1,478). Agreement between photographic-SSI and CDC-SSI was fair for open fracture wounds (83%; k = 0.27 (95% confidence interval (CI) 0.14 to 0.42)) and for closed incisional wounds (88%; k = 0.29 (95% CI 0.20 to 0.37)) although the rate of photographically detected deep SSIs was twice as high as CDC-SSI (12% vs 6%). Agreement between different assessors for photographic-SSI (WOLLF 88%, k = 0.63 (95% CI 0.52 to 0.72); WHiST 89%; k = 0.61 (95% CI 0.54 to 0.69)); and wound healing was good (WOLLF 90%; k = 0.80 (95% CI 0.73 to 0.86); WHiST 87%; k = 0.57 (95% CI 0.50 to 0.64)). Conclusion Although wound photography was feasible within the research context and inter-rater assessor agreement substantial, digital photographs used in isolation overestimated deep SSI rates, when compared to CDC criteria. Wound photography should not replace clinical assessment in pragmatic trials but may be useful for screening purposes where surgical infection outcomes are paramount. Cite this article: Bone Joint J 2021;103-B(12):1802–1808.

scholarly journals Feasibility and diagnostic accuracy of Telephone Administration of an adapted wound heaLing QuestiONnaire for assessment for surgical site infection following abdominal surgery in low and middle-income countries (TALON): protocol for a study within a trial (SWAT)

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
◽  
James Glasbey ◽  
Victoria Adeyeye ◽  
Adesoji Ademuyiwa ◽  
Alisha Bhatt ◽  
...  
Keyword(s):  
Wound Healing ◽  
Abdominal Surgery ◽  
Diagnostic Accuracy ◽  
Surgical Site Infection ◽  
Hospital Discharge ◽  
Site Infection ◽  
Middle Income ◽  
Middle Income Countries ◽  
Wound Assessment ◽  
Study Within A Trial

Abstract Background Surgical site infection is the most common complication of abdominal surgery, with a global impact on patients and health systems. There are no tools to identify wound infection that are validated for use in the global setting. The overall aim of the study described in this protocol is to evaluate the feasibility and validity of a remote, digital pathway for wound assessment after hospital discharge for patients in low- and middle-income countries (LMICs). Methods A multi-centre, international, mixed-methods study within a trial, conducted in two stages (TALON-1 and TALON-2). TALON-1 will adapt and translate a universal reporter outcome measurement tool (Bluebelle Wound Healing Questionnaire, WHQ) for use in global surgical research (SWAT store registration: 126) that can be delivered over the telephone. TALON-2 will evaluate a remote wound assessment pathway (including trial retention) and validate the diagnostic accuracy of this adapted WHQ through a prospective cohort study embedded within two global surgery trials. Embedded community engagement and involvement activities will be used to optimise delivery and ensure culturally attuned conduct. TALON-1 and TALON-2 are designed and will be reported in accordance with best practice guidelines for adaptation and validation of outcome measures, and diagnostic test accuracy studies. Discussion Methods to identify surgical site infection after surgery for patients after hospital discharge have the potential to improve patient safety, trial retention, and research efficiency. TALON represents a large, pragmatic, international study co-designed and delivered with LMIC researchers and patients to address an important research gap in global surgery trial methodology.

scholarly journals Diagnosing Surgical Site Infection Using Wound Photography: A Scenario-Based Study

2017 ◽  
Vol 224 (1) ◽  
pp. 8-15.e1 ◽  
Author(s):  
Patrick C. Sanger ◽  
Vlad V. Simianu ◽  
Cameron E. Gaskill ◽  
Cheryl A.L. Armstrong ◽  
Andrea L. Hartzler ◽  
...  
Keyword(s):  
Surgical Site Infection ◽  
Site Infection ◽  
Wound Photography

scholarly journals Economic outcomes associated with deep surgical site infection in patients with an open fracture of the lower limb

2018 ◽  
Vol 100-B (11) ◽  
pp. 1506-1510 ◽  
Author(s):  
B. Parker ◽  
S. Petrou ◽  
J. P. M. Masters ◽  
F. Achana ◽  
M. L. Costa
Keyword(s):  
Quality Of Life ◽  
Lower Limb ◽  
Open Fracture ◽  
Site Infection ◽  
Health Related Quality ◽  
Economic Costs ◽  
Related Quality ◽  
Health Related ◽  
Deep Surgical Site Infection

Aims The aim of this study was to estimate economic outcomes associated with deep surgical site infection (SSI) in patients with an open fracture of the lower limb. Patients and Methods A total of 460 patients were recruited from 24 specialist trauma hospitals in the United Kingdom Major Trauma Network. Preference-based health-related quality-of-life outcomes, assessed using the EuroQol EQ-5D-3L and the 6-Item Short-Form Health Survey questionnaire (SF-6D), and economic costs (£, 2014/2015 prices) were measured using participant-completed questionnaires over the 12 months following injury. Descriptive statistics and multivariate regression analysis were used to explore the relationship between deep SSI and health utility scores, quality-adjusted life-years (QALYs), and health and personal social service (PSS) costs. Results Deep SSI was associated with lower EQ-5D-3L derived QALYs (adjusted mean difference -0.102, 95% confidence interval (CI) -0.202 to 0.001, p = 0.047) and increased health and social care costs (adjusted mean difference £1950; 95% CI £1383 to £5285, p = 0.250) versus patients without deep SSI over the 12 months following injury. Conclusion Deep SSI may lead to significantly impaired health-related quality of life and increased economic costs. Our economic estimates can be used to inform clinical and budgetary service planning and can act as reference data for future economic evaluations of preventive or treatment interventions. Cite this article: Bone Joint J 2018;100-B:1506–10.

scholarly journals Negative-pressure wound therapy compared with standard dressings following surgical treatment of major trauma to the lower limb: the WHiST RCT

2020 ◽  
Vol 24 (38) ◽  
pp. 1-86
Author(s):  
Matthew L Costa ◽  
Juul Achten ◽  
Ruth Knight ◽  
May Ee Png ◽  
Julie Bruce ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Surgical Site Infection ◽  
Negative Pressure ◽  
Lower Limb ◽  
Negative Pressure Wound Therapy ◽  
Major Trauma ◽  
Site Infection ◽  
Wound Therapy ◽  
Deep Surgical Site Infection

Background Major trauma is the leading cause of death in people aged < 45 years. Patients with major trauma usually have lower-limb fractures. Surgery to fix the fractures is complicated and the risk of infection may be as high as 27%. The type of dressing applied after surgery could potentially reduce the risk of infection. Objectives To assess the deep surgical site infection rate, disability, quality of life, patient assessment of the surgical scar and resource use in patients with surgical incisions associated with fractures following major trauma to the lower limbs treated with incisional negative-pressure wound therapy versus standard dressings. Design A pragmatic, multicentre, randomised controlled trial. Setting Twenty-four specialist trauma hospitals representing the UK Major Trauma Network. Participants A total of 1548 adult patients were randomised from September 2016 to April 2018. Exclusion criteria included presentation > 72 hours after injury and inability to complete questionnaires. Interventions Incisional negative-pressure wound therapy (n = 785), in which a non-adherent absorbent dressing covered with a semipermeable membrane is connected to a pump to create a partial vacuum over the wound, versus standard dressings not involving negative pressure (n = 763). Trial participants and the treating surgeon could not be blinded to treatment allocation. Main outcome measures Deep surgical site infection at 30 days was the primary outcome measure. Secondary outcomes were deep infection at 90 days, the results of the Disability Rating Index, health-related quality of life, the results of the Patient and Observer Scar Assessment Scale and resource use collected at 3 and 6 months post surgery. Results A total of 98% of participants provided primary outcome data. There was no evidence of a difference in the rate of deep surgical site infection at 30 days. The infection rate was 6.7% (50/749) in the standard dressing group and 5.8% (45/770) in the incisional negative-pressure wound therapy group (intention-to-treat odds ratio 0.87; 95% confidence interval 0.57 to 1.33; p = 0.52). There was no difference in the deep surgical site infection rate at 90 days: 13.2% in the standard dressing group and 11.4% in the incisional negative-pressure wound therapy group (odds ratio 0.84, 95% confidence interval 0.59 to 1.19; p = 0.32). There was no difference between the two groups in disability, quality of life or scar appearance at 3 or 6 months. Incisional negative-pressure wound therapy did not reduce the cost of treatment and was associated with a low probability of cost-effectiveness. Limitations Owing to the emergency nature of the surgery, we anticipated that some patients who were randomised would subsequently be unable or unwilling to participate. However, the majority of the patients (85%) agreed to participate. Therefore, participants were representative of the population with lower-limb fractures associated with major trauma. Conclusions The findings of this study do not support the use of negative-pressure wound therapy in patients having surgery for major trauma to the lower limbs. Future work Our work suggests that the use of incisional negative-pressure wound therapy dressings in other at-risk surgical wounds requires further investigation. Future research may also investigate different approaches to reduce postoperative infections, for example the use of topical antibiotic preparations in surgical wounds and the role of orthopaedic implants with antimicrobial coatings when fixing the associated fracture. Trial registration Current Controlled Trials ISRCTN12702354 and UK Clinical Research Network Portfolio ID20416. Funding This project was funded by the National Institute for Health Research Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 38. See the NIHR Journals Library for further project information.

Prognostic factors for surgical site infection following intramedullary nailing of diaphyseal fractures of the femur and tibia in adult patients at a tertiary hospital in Lusaka, Zambia

2021 ◽  
pp. 004947552110646
Author(s):  
Webster Musonda ◽  
Derek Freitas ◽  
Kaunda Yamba ◽  
William Jim Harrison ◽  
James Munthali
Keyword(s):  
Prognostic Factors ◽  
Surgical Site Infection ◽  
Intramedullary Nailing ◽  
Tertiary Hospital ◽  
Alternative Methods ◽  
Long Bone ◽  
Site Infection ◽  
Resource Setting ◽  
Early Return ◽  
Diaphyseal Fractures

Our study aimed to identify prognostic factors for surgical site infection following long bone fracture intramedullary nailing at a tertiary hospital in a low-resource setting. This was a longitudinal observational study involving 132 participants enrolled over a one-year period with femoral and tibial diaphyseal fractures scheduled for ORIF. Participant median age was 30 years (range: 26 – 42). The prevalence of surgical site infection was 16%. Male sex (AOR=0.26, 95% CI [0.70–0.98]; p = 0.047) was associated with lower odds of surgical site infection while associated non-musculoskeletal injuries were associated with higher odds of developing surgical site infection. Our study confirms a higher surgical site infection rate than normally accepted. However, intramedullary nailing in our setting is justified as it allows an early return to a pre-injury state. These interventions must be carried out in the best possible circumstances. Future studies could explore alternative methods of fracture fixation.

The vacuum-assisted closure (V.A.C®) system for surgical site infection with involved vascular grafts

Vascular ◽  
2014 ◽  
Vol 23 (2) ◽  
pp. 144-150 ◽  
Author(s):  
Karaca Saziye ◽  
Kalangos Afksendiyos
Keyword(s):  
Surgical Site Infection ◽  
Lower Limb ◽  
Vascular Grafts ◽  
Site Infection ◽  
Secondary Intention ◽  
Delayed Primary Closure ◽  
The Mean ◽  
Reoperation Rates ◽  
Mean Time

Background In vascular surgery, surgical site infection is the most common postoperative morbidity, occurring in 5–10% of vascular patients. The optimal management of surgical site infection with involved lower limb vascular grafts remains controversial. We present our 6-year results of using the V.A.C.® system in surgical site infection with involved vascular grafts. Methods A retrospective 6-year review of patient who underwent a VAC® therapy for postoperative surgical site infection in lower limb with involved vascular grafts in our department between January 2006 and December 2011. V.A.C therapy was used in 40 patients. All patients underwent surgical wound revision with VAC® therapy and antibiotics. Results The mean time of use of the V.A.C. system was 14.2 days. After mean of 12 days in 34 of 40 patients, in whom the use of VAC® therapy resulted in delayed primary closure or healing by secondary intention. The mean postoperative follow-up time was 61.67 months, during which 3 patients died. Conclusion We showed that the V.A.C.® system is valuable for managing specifically surgical site infection with involved vascular grafts. Using the V.A.C.® system, reoperation rates are reduced; 85% of patients avoided graft replacement.

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

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)

The principles of managing open fractures

2014 ◽  
Vol 100 (1) ◽  
pp. 20.1-25
Author(s):  
R Walker ◽  
S Middleton ◽  
S A Stapley
Keyword(s):  
Soft Tissue ◽  
Lower Limb ◽  
Open Fracture ◽  
Open Fractures ◽  
Improvised Explosive Device ◽  
Limb Fracture ◽  
Explosive Device ◽  
Improvised Explosive

AbstractAny fracture of a bone which communicates with the outside environment via a wound in the skin is classified as an open fracture. This may be from penetration by sharp objects from the exterior, laceration caused by the fracture fragments, or shearing forces that tear or de-glove soft tissue from a limb. These injuries vary in mechanism and severity, ranging from a broken finger caught in a bulkhead door to a catastrophic lower limb fracture suffered from an improvised explosive device (IED). We address the management principles that can be applied to all open fractures regardless of cause.

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