REDUCTION OF WOUND-INFECTION IN HIGH-RISK SURGICAL PATIENTS

During a 9-year period, 183 consecutive patients underwent total colec tomy and the endorectal ileal pull-through procedure (ERIPT) for ulcer ative colitis (UC) (n=156), familial polyposis (n=25), or Hirschprung' s disease (n=2). The average age was 29.4 years (range 7.1-59.1 years) . Ail patients with UC were steroid-dependent at the time of operation . Two groups were retrospectively reviewed based on the management of their midline abdominal wounds. Ninety consecutive patients underwent the ERIPT procedure between 1983 and 1987 with stapled skin closure an d perioperative intravenous antibiotics (group W). Between 1988 and 19 92, 93 patients had abdominal wall closure in the same manner, however , the wounds were probed daily in four to six sites for the first five postoperative days with a Q-tip moistened with 2 per cent aqueous mer curachrome solution (group 2A). Approximately four months after ERIPT, ileostomy closure was performed on 176 of the patients, of whom 89 ha d no wound probing (group 1B), and 87 had probing (group 2B). Followin g colectomy and the ERIPT procedure, 22/90 group 1A patients (24.4%) a nd 4/93 group 2A patients (4.3%) developed wound infections. Following ileostomy closure only 3/89 (3.4%) group 1B patients and 1/87 (1.2%) group 2B patients developed wound infections. No group 2A or B patient s required wound packing, and none had prolonged hospitalization. In c ontrast, 17 group 1A patients spent more than 1 extra day of hospitali zation (mean 2.8 days) and required wound packing a mean of 22.6 days after hospital discharge. This wound infection rate is significantly l ower for group 2A versus 1A patients (P<0.0001, ANOVA). The wound infe ction rate after ileostomy closure between groups 1B and 2B was not si gnificantly different. Wound probing to evacuate clot or seroma during the first 5 postoperative days in steroid-dependent, high-risk patien ts undergoing major colorectal surgery permits expeditious wound closu re without the need for open wound packing and delayed healing.