A Microsurgical Drainage Technique Attenuates Post-operative Infectious Complications
Emily H. Steen1, Jill M. Tuley2, Sundeep G. Keswani3.
1Baylor College of Medicine, Houston, TX, USA, 2Texas Children's Hospital, Houston, TX, USA, 3Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA.
Background: Per National Surgical Quality Improvement Program (NSQIP) reports, infection rates in contaminated and dirty wounds range from 10 to >27%. Infected or contaminated wound sites have historically been managed with incision and drainage with gauze packing or negative pressure therapy. Here, we review our experience with skin closure over vessel loops and assess the results of this technique in a variety of clinical situations, hypothesizing that microsurgical drainage improves or attenuates post-operative infectious complications. Methods: We retrospectively reviewed the data of all children with infected or contaminated wound sites operated on by a single surgeon with skin closure over vessel loops from 9/2016 to 9/2018. Demographics, indications for surgery, complications, and follow-up were assessed. Results: Over a two year period, 33 children underwent skin closure over vessel loops. The majority were female(82%), Hispanic(40%), and <5y(58%; mean 6.5y, range 4mo-16y). 33% were obese, defined as weight for age >95th percentile. Operations were classified as primary skin and soft tissue infection(SSTI; 81%), complex wound repair for trauma(12%), and enterostomy takedown(6%). 7(21%) of these patients previously presented to an outside hospital with failed intervention/management. Of the SSTIs, the extremities were the most common operative sites(30%); none were necrotizing or involved the joint. Post-operative length of stay averaged 1.5 days. 76% of patients returned to clinic for follow-up and/or vessel loop removal. At 30 days post-op, no patients in our cohort returned to the emergency room with recurrent infection or wound dehiscence. Conclusions: We report the technique of skin closure over vessel loops in contaminated wounds demonstrates no evidence of subsequent infection in standard follow-ups, an improvement over national infection rates. These results are indicative of specific advantages related to microsurgical drainage, including ease of wound maintenance and improved cosmesis, and that liberal use of vessel loops in these challenging wound classes will improve care for children.
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