Byregowda Suman, Puri Ajay, Gulia Ashish
Department of Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India.
South Asian J Cancer. 2017 Jul-Sep;6(3):99-101. doi: 10.4103/2278-330X.214572.
We retrospectively analyzed a consecutive group of patients operated for bone tumors of extremity and pelvis who received only perioperative antibiotics (Group A) against a similar group that had additional 1 g topical vancomycin sprinkled in the wound before closure (Group B). The aim was to determine if the addition of topical vancomycin decreases the incidence of deep surgical site infection (SSI).
A total of 221 patients operated between January 2011 and December 2011 were analyzed in Group A and 254 patients operated between April 2012 and March 2013 were analyzed in Group B. Any patient who required operative intervention for wound discharge was considered to be infected. All patients had a 1 year follow-up to determine the incidence of SSI.
The overall rate of SSI was 7% (31 of 475 patients). Seventeen (8%) of Group A patients had SSI as against 14 (6 %) of Group B patients ( = 0.337). A subgroup analysis of endoprosthetic reconstructions, internal fixation implants (plates/intramedullary nails), extracorporeal radiation treated bones and strut allografts showed no difference between the two groups of patients.
Our data suggest that the addition of topical vancomycin before wound closure in patients operated for bone tumors does not decrease the incidence of SSI. Further investigation of this technique using a case-controlled methodology with an increase in the dose of vancomycin may be warranted.
我们回顾性分析了一组连续接受肢体和骨盆骨肿瘤手术的患者，这些患者仅接受围手术期抗生素治疗（A组），并与另一组类似患者进行对比，后者在伤口闭合前额外撒入1克局部用万古霉素（B组）。目的是确定添加局部用万古霉素是否会降低深部手术部位感染（SSI）的发生率。
A组分析了2011年1月至2011年12月期间接受手术的221例患者，B组分析了2012年4月至2013年3月期间接受手术的254例患者。任何因伤口引流需要手术干预的患者都被视为感染病例。所有患者均进行了1年的随访以确定SSI的发生率。
SSI的总体发生率为7%（475例患者中的31例）。A组有17例（8%）患者发生SSI，而B组有14例（6%）患者发生SSI（P = 0.337）。对假体置换重建、内固定植入物（钢板/髓内钉）、体外放射治疗的骨骼和支撑异体骨的亚组分析显示，两组患者之间无差异。
我们的数据表明，对于接受骨肿瘤手术的患者，在伤口闭合前添加局部用万古霉素并不能降低SSI的发生率。可能有必要使用病例对照方法并增加万古霉素剂量对该技术进行进一步研究。
