Foreman Marco, Amador Isabella, Tabarestani Arman, Hao Kevin A, Benjamin Jonathan, Casauay Jed, Dada Oluwaferanmi, Desai Persis, Jennings Aaron, Orriols Adrienne, Popp Reed, Saengchote Supreeya A, Khlopas Anton, Hones Keegan, Hutchison Richard, Kim Jongmin, Wright Thomas W, Chughtai Morad
University of Florida, Gainesville, USA.
Henry Ford Health System, Detroit, MI, USA.
Hand (N Y). 2025 Aug 20:15589447251357042. doi: 10.1177/15589447251357042.
Presently, there is no consensus within the field of orthopedics on whether irrigation prior to wound closure in routine upper-extremity surgery reduces wound complications. Therefore, preclosure wound irrigation could provide time and cost savings. The aim of this study was to evaluate the effectiveness of wound irrigation in routine upper-extremity procedures.
We conducted a retrospective review of adult patients undergoing routine upper-extremity surgery at a single institution from 2013 to 2022. Patients were included if they underwent soft tissue upper extremity surgery. Patients were excluded for having concomitant lacerations, penetrating injuries, open fractures, or unknown irrigation technique. Our primary outcome was comparison of the rate of wound complications based on whether irrigation was used. Multivariable logistic regression was additionally used to determine whether irrigation prior to closure was associated with a lower incidence of postoperative wound complications independent of potential confounders.
We included 1425 patients. The mean age was 55.2 ± 16 years and 65% were female. The incision was irrigated prior to closure in 65% of surgeries. Wound complications occurred in 2.9% of patients (n = 41). On bivariable analysis, irrigation prior to closure was not associated with a decreased incidence of wound complications (3.5% vs 1.8%, = .070). When adjusting for age, sex, BMI, operative time, history of prior surgery, diabetes, tobacco use, corticosteroid use, and immunosuppressant use, the employment of irrigation prior to wound closure was not associated with lower odds of wound complications in either bivariable (OR: 1.99, 95% CI 0.94-4.19, = .07) or multivariable (OR: 1.88, 95% CI 0.88-4.04, = .08) analysis.
Use of irrigation prior to wound closure was not associated with a difference in the odds of postoperative wound complications. Surgeons should consider forgoing irrigation prior to closure to increase operating room efficiency and provide cost savings to the patients and payers.
目前，在骨科领域，对于常规上肢手术中伤口闭合前进行冲洗是否能减少伤口并发症尚无共识。因此，伤口闭合前冲洗可能节省时间和成本。本研究的目的是评估伤口冲洗在常规上肢手术中的有效性。
我们对2013年至2022年在一家机构接受常规上肢手术的成年患者进行了回顾性研究。纳入接受上肢软组织手术的患者。排除伴有撕裂伤、穿透伤、开放性骨折或冲洗技术不明的患者。我们的主要结局是根据是否使用冲洗来比较伤口并发症的发生率。此外，使用多变量逻辑回归来确定闭合前冲洗是否与术后伤口并发症的较低发生率相关，而不受潜在混杂因素的影响。
我们纳入了1425例患者。平均年龄为55.2±16岁，65%为女性。65%的手术在闭合前进行了切口冲洗。2.9%的患者（n = 41）发生了伤口并发症。在双变量分析中，闭合前冲洗与伤口并发症发生率降低无关（3.5%对1.8%，P = 0.070）。在调整年龄、性别、体重指数、手术时间、既往手术史、糖尿病、吸烟、使用皮质类固醇和使用免疫抑制剂后，伤口闭合前使用冲洗在双变量（OR：1.99，95%CI 0.94 - 4.19，P = 0.07）或多变量（OR：1.88，95%CI 0.88 - 4.04，P = 0.08）分析中均与伤口并发症的较低几率无关。
伤口闭合前使用冲洗与术后伤口并发症几率的差异无关。外科医生应考虑在闭合前放弃冲洗，以提高手术室效率，并为患者和支付方节省成本。
