Suh Insoo, Long Sarah A, Coe Jonathan, Koehler Jeremy, Fry Donald, Welton Mark L
1 Department of Surgery, University of California , San Francisco, California.
2 Fogarty Institute for Innovation , Mountain View, California.
J Laparoendosc Adv Surg Tech A. 2018 Apr;28(4):445-451. doi: 10.1089/lap.2017.0403. Epub 2017 Aug 28.
Surgical site infections (SSIs) remain a morbid and costly complication in abdominal surgery. Topical antibiotic delivery via intraoperative irrigation and barrier wound protection are strategies for preventing SSI. We tested the safety and efficacy of a novel wound protector device with an integrated fluid irrigation platform in a porcine model.
A simulated colorectal resection model was designed and performed on adult female pigs with a standardized concentration of 10 colony-forming units (CFU) of Escherichia coli administered to the wound site in 10 mL of normal saline (n = 7). The device was tested intraoperatively with and without irrigation with gentamicin-containing irrigant solution. Swab and tissue samples were obtained in addition to peripheral blood samples. Quantitative culture analysis was performed in addition to histological and immunohistochemical analysis and gentamicin concentration measurements.
There were no adverse events observed in the animals. Tissue protected by the device yielded exponentially lower levels of E. coli growth compared to exposed tissue, with a mean 1 × 10 CFU/swab. Use of the device, both with and without irrigation, was associated with an exponential reduction in quantitative bacterial load compared to the control wounds with no device, with limited growth after wound closure in the pigs receiving irrigation. Histology and terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) staining analysis revealed no significant damage to tissue. Serum gentamicin levels remained below the clinical threshold and decreased over time.
This in vivo study suggests safety and efficacy of a novel device for the prevention of intraoperative wound contamination.
手术部位感染（SSIs）仍是腹部手术中一种具有高发病率且成本高昂的并发症。通过术中冲洗进行局部抗生素给药以及屏障伤口保护是预防手术部位感染的策略。我们在猪模型中测试了一种带有集成液体冲洗平台的新型伤口保护装置的安全性和有效性。
设计并在成年雌性猪身上进行了模拟结直肠切除模型，将标准化浓度为10个菌落形成单位（CFU）的大肠杆菌以10毫升生理盐水的形式施用于伤口部位（n = 7）。术中在使用含庆大霉素的冲洗液冲洗和不冲洗的情况下对该装置进行测试。除了采集外周血样本外，还获取了拭子和组织样本。除了进行组织学、免疫组织化学分析以及庆大霉素浓度测量外，还进行了定量培养分析。
在动物中未观察到不良事件。与暴露组织相比，受该装置保护的组织中大肠杆菌生长水平呈指数级降低，平均每拭子为1×10 CFU。与未使用该装置的对照伤口相比，无论是否冲洗，使用该装置均与定量细菌载量呈指数级降低相关，在接受冲洗的猪中伤口闭合后生长有限。组织学和末端脱氧核苷酸转移酶dUTP缺口末端标记（TUNEL）染色分析显示对组织无明显损伤。血清庆大霉素水平保持在临床阈值以下并随时间下降。
这项体内研究表明一种新型装置在预防术中伤口污染方面具有安全性和有效性。
