Journal
AMERICAN JOURNAL OF SURGERY
Volume 198, Issue 3, Pages 381-386Publisher
EXCERPTA MEDICA INC-ELSEVIER SCIENCE INC
DOI: 10.1016/j.amjsurg.2008.12.021
Keywords
Wound infection; Wound irrigation; Pulse lavage irrigation; Pressure; Laparotomy; Fat necrosis
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BACKGROUND: Surgical site infections cause significant postoperative morbidity and may be reduced by pressurized irrigation of high-risk laparotomy wounds before closure. This was a retrospective review (June 2007 to May 2008) from a surgical unit at a tertiary care center. METHODS: Patients undergoing laparotomy extending beyond 4 hours, when a standard wound management strategy was instituted by either simple irrigation or pressurized pulsatile lavage (< 15 psi) with saline before closure, were included. The outcome measures were the surgical site infections and factors contributing to them. RESULTS: The median surgical time for the patients was 8 hours, with 34 wounds managed by simple irrigation and 42 wounds managed by pulse irrigation. Both groups had similar characteristics. Overall there were 15 (20%) surgical site infections. Significantly fewer infections occurred in the pulse irrigation group (10% vs 32%; P = .019). The use of a pulse irrigation device was the only factor associated with a reduction in wound infections (P = .019). CONCLUSIONS: Surgical site infections appear to be reduced with pulsatile lavage irrigation of wounds before skin closure in patients undergoing prolonged intra-abdominal surgeries. (C) 2009 Elsevier Inc. All rights reserved.
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