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Vascular surgical site infection (VSSI) rates vary from 1-2% for endovascular or open aortic repairs, to 10-20% in lower limb bypass procedures. It is imperative to minimize the risk of VSSI, given the potentially devastating consequences associated with graft infection.
The aim of this study is to assess the influence of Wound Closure Techniques on the incidence of VSSI rates in a Tertiary Vascular Referral Centre. End-Points included VSSI rates, impact of patient-specific factors, and re-intervention rates.
Data for all patients referred to our centre from 2005-2010 was obtained from the prospectively maintained Vascubase dataset. A subset of patients was assigned to a specific method of wound closure. This rigorous technique included pulse-lavage with antibiotic wash, closure in layers with absorbable sutures, and a subcuticular skin suture with non-dyed monocryl. Tissue adhesive (Dermabond) was then used to seal the dressing. No dressing was applied to the wound. Neither pulse-lavage nor dermabond were used in the remaining patients. A comparative analysis between the two groups was performed, including multivariate analysis of patient-specific factors including Diabetes Mellitus, hypertension, hyperlipidaemia and smoking history.
Over a three year period, 1691 patients were assigned to the Pulse-Lavage/Dermabond cohort. The mean age of these patients was 68.41years. In this group, only 17 patients developed VSSI (1.01%, p=0.608) : 4 following open AAA repair (5.13%), 5 following bypass procedures (2.84%), 4 following angioplasty (1.29%), 3 following varicose vein surgeries (0.57%), and 1 following EVAR (1.06%).
The most common wound site was groin wound (n=11, p 0.019), abdominal wound (n=4) and thigh wound (n=2). 10 re-intervention procedures for VSSI were performed and 7 VSSI settled on antibiotics alone. 5 organisms responsible for the infection were isolated, MRSA was the most common (n=2). Median length of stay was 21days.
VSSI rates depend not only on patient-specific factors but also on methods of wound closure, with a specific strategy using Pulse Lavage and Dermabond giving favourable results compared to controls and VSSI rates previously recorded in the literature.