Non-pharmacologic Prevention of Surgical Wound Infection

Sessler, Daniel I.

doi:10.1016/j.atc.2006.01.005

Cited by 60 publications

(29 citation statements)

References 116 publications

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“…Haemoglobin amongst other factors (cardiac output, local perfusion, etc.) is known to influence tissue oxygenation and perfusion [16]. This underlines the need for prompt fluid and blood replacement in resuscitation of these patients to reduce the incidence of stump wound infection and its associated morbidity.…”

Section: Discussionmentioning

confidence: 99%

An analysis of risk factors associated with traumatic extremity amputation stump wound infection in a Nigerian setting

Omoke

Nwigwe

2012

International Orthopaedics (SICOT)

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Purpose We aimed to determine the risk factors associated with traumatic extremity amputation stump wound infection in our environment. Method This was a retrospective analysis of databases that included the entire patient population with traumatic extremity amputation seen in Ebonyi State University Teaching Hospital and Federal Medical Centre Abakaliki from January 2001 to December 2011. Result There were 63 patients studied and stump wound infection was a complication in 38 (60 %) of them. Stump wound infection rate significantly correlated with the form of amputation, i.e., a higher rate in crushing than guillotine (sharp clear-cut) amputation (80.5 vs. 22.7 % p<0.000); severity, i.e., a higher rate in major than minor amputation (80.6 vs. 33.3 % p<0.000); and limb involvement, i.e., a higher rate in lower than upper extremity amputation (71.1 vs. 60.7 % p<0.002). Haematocrit level on admission (p< 0.002), injury to hospital admission interval (p<0.012) and injury to first surgical debridement / amputation interval (p< 0.02) were all significantly related to incidence of wound infection. Multivariate analysis identified crushing amputation as an independent risk factor (p<0.009) for traumatic amputation stump wound infection. Conclusion The only independent predictor of traumatic extremity amputation stump wound infection is a crushing form of amputation; it should be accorded a high priority in interventions aimed at reducing infection rate

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Section: Discussionmentioning

confidence: 99%

An analysis of risk factors associated with traumatic extremity amputation stump wound infection in a Nigerian setting

Omoke

Nwigwe

2012

International Orthopaedics (SICOT)

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“…Due to lower body temper-ature, reduced metabolism, extreme overwinter weight loss and complete lack of protein intake (Harlow et al 2002(Harlow et al , 2004Lohuis et al 2005), it might be expected that the wounds of denning bears, such as those incurred just prior to hibernation, would not easily heal. In part, this assumption is based on decreased rates of wound healing and/or abnormal foreign body rejection responses in hypothermic humans (Beilin et al 1998;Remick & Xioa 2006;Sessler 2006). Inadequate wound healing in humans leads to impaired quality of life, pain, loss of work productivity and costly treatments.…”

Section: Introductionmentioning

confidence: 99%

Wound healing during hibernation by black bears (Ursus americanus) in the wild: elicitation of reduced scar formation

Iaizzo

Laske

Harlow

et al. 2012

Integrative Zoology

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Even mildly hypothermic body or limb temperatures can retard healing processes in mammals. Despite this, we observed that hibernating American black bears (Ursus americanus Pallas, 1780) elicit profound abilities in mounting inflammatory responses to infection and/or foreign bodies. In addition, they resolve injuries during hibernation while maintaining mildly hypothermic states (30-35 °C) and without eating, drinking, urinating or defecating. We describe experimental studies on free-ranging bears that document their abilities to completely resolve cutaneous cuts and punctures incurred during or prior to hibernation. We induced small, full-thickness cutaneous wounds (biopsies or incisions) during early denning, and re-biopsied sites 2-3 months later (near the end of denning). Routine histological methods were used to characterize these skin samples. All biopsied sites with respect to secondary intention (open circular biopsies) and primary intention (sutured sites) healed, with evidence of initial eschar (scab) formation, completeness of healed epidermis and dermal layers, dyskeratosis (inclusion cysts), and abilities to produce hair follicles. These healing abilities of hibernating black bears are a clear survival advantage to animals injured before or during denning. Bears are known to have elevated levels of hibernation induction trigger (delta-opioid receptor agonist) and ursodeoxycholic acid (major bile acid within plasma, mostly conjugated with taurine) during hibernation, which may relate to these wound-healing abilities. Further research as to the underlying mechanisms of wound healing during hibernation could have applications in human medicine. Unique approaches may be found to improve healing for malnourished, hypothermic, diabetic and elderly patients or to reduce scarring associated with burns and traumatic injuries.

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“…This antimicrobial action relies on the production of superoxide radicals from oxygen, which is dependent on the partial pressure of oxygen within the tissues. [6][7][8] Increasing the inspired oxygen concentration has been shown to increase tissue oxygen tension. 9 Randomized controlled trials (RCTs) have been completed in the last decade to determine the effect of highconcentration inspired oxygen on the rate of SSIs in pa tients undergoing surgery.…”

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confidence: 99%

High-concentration oxygen and surgical site infections in abdominal surgery: a meta-analysis

Patel

Coughlin²,

Malthaner³

2013

cjs

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Background: There has been recent interest in using high-concentration oxygen to prevent surgical site infections (SSIs). Previous meta-analyses in this area have produced conflicting results. With the publication of 2 new randomized controlled trials (RCTs) that were not included in previous meta-analyses, an updated review is warranted. Our objective was to perform a meta-analysis on RCTs comparing high-and low-concentration oxygen in adults undergoing open abdominal surgery. Methods:We completed independent literature reviews using electronic databases, bibliographies and other sources of grey literature to identify relevant studies. We assessed the overall quality of evidence using grade guidelines. Statistical analysis was performed on pooled data from included studies. A priori subgroup analyses were planned to explain statistical and clinical heterogeneity. Results:Overall, 6 studies involving a total of 2585 patients met the inclusion criteria. There was no evidence of a reduction in SSIs with high-concentration oxygen (risk ratio 0.77, 95% confidence interval 0.50-1.19, p = 0.24). We observed substantial heterogeneity among studies. Conclusion: There is moderate evidence that high-concentration oxygen does not reduce SSIs in adults undergoing open abdominal surgery.Contexte : On observe depuis peu un intérêt à l'endroit de l'oxygène à concentration élevée pour prévenir les infections de plaies opératoires. Les méta-analyses réalisées dans le passé à ce sujet ont donné des résultats divergents. Compte tenu de la publication de 2 nouveaux essais randomisés et contrôlés (ERC) qui n'ont pas été inclus dans les méta-analyses précédentes, une nouvelle revue de la situation s'imposait. Notre objectif était donc d'effectuer une méta-analyse des ERC, qui ont comparé l'oxygène à concentration élevée et faible chez des adultes soumis à une chirurgie abdominale ouverte.Méthodes : Nous avons effectué des analyses indépendantes de la littérature à partir de bases de données électroniques, de bibliographies et autres éléments de la littéra-ture « grise » pour identifier les études pertinentes. Nous avons classé la qualité globale des données probantes selon les lignes directrices de catégorisation. L'analyse statistique a porté sur les données regroupées des études incluses. Des analyses de sous-groupes ont été planifiées a priori pour expliquer l'hétérogénéité statistique et clinique.Résultats : En tout, 6 études regroupant 2585 patients répondaient aux critères d'inclusion. On n'a noté aucune preuve de réduction des infections de plaies opératoires associées à l'oxygène à concentration élevée (risque relatif 0,77, intervalle de confiance de 95 % 0,50-1,19, p = 0,24). Nous avons observé une forte hétérogénéité entre les études. Conclusion :On dispose de données probantes acceptables selon lesquelles l'oxygène à concentration élevée ne réduit pas les infections de plaies opératoires chez les adultes soumis à une chirurgie abdominale ouverte. Surgical site infections (SSIs) are a source of patient morbidity and mortali...

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Non-pharmacologic Prevention of Surgical Wound Infection

Cited by 60 publications

References 116 publications

An analysis of risk factors associated with traumatic extremity amputation stump wound infection in a Nigerian setting

An analysis of risk factors associated with traumatic extremity amputation stump wound infection in a Nigerian setting

Wound healing during hibernation by black bears (Ursus americanus) in the wild: elicitation of reduced scar formation

High-concentration oxygen and surgical site infections in abdominal surgery: a meta-analysis

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