Bacterial growth and wound infection following saphenous vein harvesting in cardiac surgery: a randomized controlled trial of the impact of microbial skin sealant

Abstract

The aim of the present study was to compare microbial skin sealant versus bare skin on the leg regarding intraoperative bacterial presence in the surgical wound and time to recolonization of the adjacent skin at the saphenous vein harvesting site. A second aim was to evaluate the incidence of leg wound infection 2 months after surgery. In this randomized controlled trial, 140 patients undergoing coronary artery bypass grafting (CABG) between May 2010 and October 2011 were enrolled. Bacterial samples were taken preoperatively and intraoperatively at multiple time points and locations. OF the patients, 125 (92.6 %) were followed up 2 months postoperatively regarding wound infection. Intraoperative bacterial growth did not differ between the bare skin (n = 68) and the microbial skin sealant group (n = 67) at any time point. At 2 months postoperatively, 7/61 patients (11.5 %) in the skin sealant versus 14/64 (21.9 %) in the bare skin group (p = 0.120) had been treated with antibiotics for a verified or suspected surgical site infection (SSI) at the harvest site. We found almost no intraoperative bacterial presence on the skin or in the subcutaneous tissue, irrespective of microbial skin sealant use. In contrast, we observed a relatively high incidence of late wound infection, indicating that wound contamination occurred postoperatively. Further research is necessary to determine whether the use of microbial skin sealant reduces the incidence of leg wound infection at the saphenous vein harvest site.

Perioperative routines and surgical techniques for saphenous vein harvesting in CABG surgery: a national cross-sectional study in Sweden

“…Almost all of the OT nurses had a separate table and/or separate instruments for the vein harvesting, a standard routine which probably stems from a general belief that bacteria can spread from the leg wound to the sternotomy. However, in contradiction of this belief, we showed in a previous study that there is almost no intraoperative bacterial growth on the skin or in the subcutaneous tissue at the harvest site on the leg [18]. In contrast, there is bacterial growth subcutaneously in the sternotomy during surgery in most patients [21].…”

“…The survey was sent to all OT nurses and surgeons, since it was not possible to select only those who performed CABG. The study-specific questionnaires were based on both existing research [1,2,8,9,11,[14][15][16][17][18] and the authors' own clinical experience as OT nurses, a nurse, and a cardiothoracic surgeon.…”

A comparison of the efficacy of 70% v/v isopropyl alcohol with either 0.5% w/v or 2% w/v chlorhexidine gluconate for skin preparation before harvest of the long saphenous vein used in coronary artery bypass grafting

“…3 Historically, few studies have assessed preventative strategies directed at harvest-site SSIs; however, approaches such as the use of a minimally invasive vein harvest technique, topical application of autologous platelet-rich plasma, and use of a microbial skin sealant have recently been evaluated. 1,[4][5][6] The source of most pathogens causative of SSI is the endogenous flora, primarily the patient's skin. 7 Optimal skin antisepsis is therefore an important consideration in the prevention of SSI.…”

Editorial on the article entitled “Secondary surgical-site infection after coronary artery bypass grafting: A multi-institutional prospective cohort study”

“…Other methods other than endoscopic harvesting have been adopted or are under evaluation in order to reduce leg SSIs after saphenous vein grafting but their results are not definitely conclusive. Bridged incisions instead of a single linear incision, the use of postoperative antimicrobial skin sealant attachments, and biostatic triclosan-coated sutures were proved ineffective or are still a matter of debate (19)(20)(21). Biancari et al compared the rates of SSIs and wound dehiscence after staples versus traditional sutures for skin closure after SVG harvesting for CABG, but they found no evidence of a difference in the risk of SSI between both approaches (22).…”