Fluid Collections in Amputations Are Not Indicative or Predictive of Infection

Abstract

Background In the acute postoperative period, fluid collections are common in lower extremity amputations. Whether these fluid collections increase the risk of infection is unknown. Questions/purposes The purposes of this study were to determine (1) the percentage of patients who develop postoperative fluid collections in posttraumatic amputations and the natural course of the collection; (2) whether patients who develop these collections are at increased risk for infection; and to ask (3) are there objective clinical or radiologic signs that are associated with likelihood of infection when a fluid collection is present?Methods We performed a review of all 300 patients injured in combat operations who sustained at least one major lower extremity amputation (at or proximal to the tibiotalar joint) and were treated definitively at our institution between March 2005 and April 2009. We segregated the groups based on whether cross-sectional imaging was performed less than 3 months (early group) after closure, greater than 3 months (late group) after closure, or not at all (control group, baseline frequency of infection). Our primary study cohort where those patients with a fluid collection in the first three months. The clinical course was reviewed and the primary outcome was a return to the operating room for irrigation and débridement with positive cultures. For those patients with cross-sectional imaging, we also collected objective clinical parameters within 24 hours of the scan (white blood cell count, maximum temperature, presence of bacteremia, tachycardia, oxygen desaturation), extremity examination (presence of erythema, warmth, and/or drainage), and characteristics of the fluid collections seen (size of the fluid collection, Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request. Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

Preclosure spectroscopic differences between healed and dehisced traumatic wounds

“…This is consistent with our previously reported findings, that despite different injury mechanisms, biologic responses are similar in military and civilian extremity injury patients. [ 7 ] Furthermore, in larger cohorts of related studies[ 3 ], similar rates of dehiscence are observed, which speaks to the generalizability of our findings. In the larger military patient cohort, the mean wound dehiscence rate was 13% less than presented in this study; our inflated wound dehiscence rate for military patients in this study can be attributed to sample size–the larger study includes 116 wounds while our study includes 30 wounds.…”

End-capping of amputation stumps with a local antibiotic containing hydroxyapatite bio-composite - A report of 13 cases with chronic lower limb osteomyelitis

“…Study done by Wadhwani et al showed 43% of stump problems in lower limb amputees. 13 Similarly, Polfer et al 5 reported on 300 cases of major lower limb amputation as having a return to surgery rate of 23% due to early hematoma formation. All these complications prolong hospitalisation and delay functional recovery.…”

Intrawound Antibiotic Powder Decreases Frequency of Deep Infection and Severity of Heterotopic Ossification in Combat Lower Extremity Amputations

“…Next, our primary outcome measure, deep infection, was assessed by the findings of intraoperative cultures that were taken during débridement or revision surgery; therefore, subclinical or superficial infection did not receive consideration in our study. The decision to return for reoperation was made by the primary surgeon in nearly all cases, and was based on a reliable clinical picture concerning for infection taking into account pain, wound drainage or overt dehiscence, erythema, systemic inflammatory response, and elevated inflammatory markers [19]. The use of positive cultures as a component of the endpoint prevents this outcome measure from being unduly biased by false-positive indications for reoperation.…”