CONTAMINATED WOUNDS - INFECTION-RATES WITH SUBCUTANEOUS SUTURES

Study objective: To determine whether buried absorbable subcutaneous s utures (BASS) increase the infection rate in irrigated contaminated wo unds. Methods: This was a randomized, prospective trial in a rat model , with the histologist blinded to treatment group. A single 2-cm dorsa l incision was made on each of 30 anesthetized 250-g Sprague-Dawley ra ts and inoculated with approximately 10(8) organisms of Staphylococcus aureus. After irrigation, 15 wounds were closed with running 4-0 nylo n transdermal sutures, and 15 were closed with three interrupted 4-0 c oated polyglactin 910 (Vicryl) subcuticular sutures (BASS) and running 4-0 nylon transdermal sutures. On day 7, wounds were scored on a scal e of 0 to 3 in six categories: inflammatory infiltrates, fibroplasia a nd capillary proliferation, necrosis, exudates, giant cells, and edema . The possible range for the cumulative wound score was 0 (no inflamma tion) to 18 (severe inflammation and infection). Results: The median t otal wound score in wounds closed with BASS was 14 (range, 7 to 16), i t was 8 (range, 5 to 15) for wounds closed without BASS (P=.0004). The subscores for inflammation, necrosis, exudate, and edema were also si gnificantly higher in wounds closed with BASS. Conclusion: BASS increa se the infection rate and the degree of inflammation in contaminated w ounds, despite thorough irrigation.