Papaconstantinou Harry T, Ricciardi Rocco, Margolin David A, Bergamaschi Roberto, Moesinger Robert C, Lichliter Warren E, Birnbaum Elisa H
Department of Surgery, Baylor Scott & White Healthcare, Texas A&M University College of Medicine, 2401 South 31st Street, Temple, TX, USA.
Massachusetts General Hospital, Boston, MA, USA.
World J Surg. 2018 Sep;42(9):3000-3007. doi: 10.1007/s00268-018-4568-z.
Surgical site infection (SSI) remains a persistent and morbid problem in colorectal surgery. Key to its pathogenesis is the degree of intraoperative bacterial contamination at the surgical site. The purpose of this study was to evaluate a novel wound retractor at reducing bacterial contamination.
A prospective multicenter pilot study utilizing a novel wound retractor combining continuous irrigation and barrier protection was conducted in patients undergoing elective colorectal resections. Culture swabs were collected from the incision edge prior to device placement and from the exposed and protected incision edge prior to device removal. The primary and secondary endpoints were the rate of enteric and overall bacterial contamination on the exposed incision edge as compared to the protected incision edge, respectively. The safety endpoint was the absence of serious device-related adverse events.
A total of 86 patients were eligible for analysis. The novel wound retractor was associated with a 66% reduction in overall bacterial contamination at the protected incision edge compared to the exposed incision edge (11.9 vs. 34.5%, P < 0.001), and 71% reduction in enteric bacterial contamination (9.5% vs. 33.3%, P < 0.001). The incisional SSI rate was 2.3% in the primary analysis and 1.2% in those that completed the protocol. There were no adverse events attributed to device use.
A novel wound retractor combining continuous irrigation and barrier protection was associated with a significant reduction in bacterial contamination. Improved methods to counteract wound contamination represent a promising strategy for SSI prevention (NCT 02413879).
手术部位感染（SSI）仍是结直肠手术中持续存在且会引发疾病的问题。其发病机制的关键在于手术部位术中细菌污染的程度。本研究的目的是评估一种新型伤口牵开器在减少细菌污染方面的效果。
对接受择期结直肠切除术的患者进行了一项前瞻性多中心试点研究，该研究使用了一种结合持续冲洗和屏障保护功能的新型伤口牵开器。在放置器械前从切口边缘采集培养拭子，在移除器械前从暴露且受保护的切口边缘采集培养拭子。主要和次要终点分别是暴露切口边缘与受保护切口边缘相比的肠道细菌污染率和总体细菌污染率。安全终点是未发生与器械相关的严重不良事件。
共有86例患者符合分析条件。与暴露的切口边缘相比，新型伤口牵开器使受保护切口边缘的总体细菌污染减少了66%（11.9%对34.5%，P＜0.001），肠道细菌污染减少了71%（9.5%对33.3%，P＜0.001）。在初步分析中，切口SSI发生率为2.3%，在完成方案的患者中为1.2%。未发生因使用器械导致的不良事件。
一种结合持续冲洗和屏障保护功能的新型伤口牵开器可显著减少细菌污染。改进对抗伤口污染的方法是预防SSI的一种有前景的策略（NCT 02413879）。
