Prevention of deep wound infection in morbidly obese patients by infusion of an antibiotic into the subcutaneous space at the time of wound closure

Background: Wound infections have been reported to occur in as many as 15% of wounds following the open procedure for gastric bypass in morbidly obese patients, resulting in significant disability, an increased health-care expenditure, and even death. Methods: This study was performed to assess the potential for reduction of wound infection in patients undergoing open gastric bypass by using a multimodal application of measures including infusion of an antibiotic (kanamycin) into the wound after closure and allowing it to dwell for 2 hours. Follow-up was for a minimum of 6 weeks. Results: Of 400 consecutive evaluable patients, none had a wound infection which started in the subcutaneous fat or fascia. One patient had a stitch abscess, two had superficial infections secondary to wound separation after suture removal, and one had infection after spontaneous evacuation of a seroma. Conclusion: Using an infusion of kanamycin into the wound and allowing it to dwell for a 2-hour period, along with other standard preventive measures, eliminated primary deep subcutaneous and fascial wound infections after open gastric bypass procedures.