Wound infection following stoma reversal: a prospective comparative study between primary closure and partial closure with intervening silver dressings

Autor: N. Qisti, J. Y. Soo, T. Gee, K. W. Ong, N. H. Zubaidah
Rok vydání: 2016
Předmět:
Zdroj: International Journal of Colorectal Disease. 31:1381-1382
ISSN: 1432-1262
0179-1958
DOI: 10.1007/s00384-015-2487-0
Popis: Dear Editor: Closure of gastrointestinal tract stoma has been traditionally regarded as a clean-contaminated operative procedure that is associated with a high incidence of surgical site infection (SSI). The stomas have an increased bio-burden due to the nature of the enteric contents. Therefore, wounds following stoma closure are likely to be contaminated. This invariably leads to surgeons in treating the wound as such with either delayed primary closure or healing by secondary intention as compared to primary closure (PC). There are relatively few studies to show that PC is as good as, if not better, than other wound closure methods in terms of SSI rates. However, to date, which method provides the least SSI rate is still a subject to debate and a consensus has yet to be achieved. As a consequence, a few modified methods of wound closure following stoma reversal have evolved to provide alternatives to PC. One of the alternative method is by closing the wound partially with interrupted sutures interspersed with dressings. Recently, there has been an increase in the use of silver as an antimicrobial agent. A silver-containing Hydrofiber dressing, Aquacel® Ag (ConvaTec), is capable of managing exudates better than conventional absorptive fibrous dressings. The core of this dressing is made of sodium carboxymethylcellulose that is designed to absorb exudate effectively subsequently releasing ionic silver into the wound environment in a controlled manner. The carboxymethylcellulose and silver components therefore makes Aquacel® Ag an ideal antimicrobial dressing for contaminated wounds such as wounds following stoma reversals. Therefore, the aim of this study is to describe and evaluate a new method of wound closure following stoma reversals by performing partial closure with intervening silver dressings. A comparison of the new method is made with a PC, and the SSI rates among both these groups were studied. Although the method of using partial closure with intervening dressings has been described, the use of silver-containing dressings has yet to be elucidated. A total 44 patients were randomized into two groups from two public hospitals from January 2011 until April 2015. The study group consists of patients who had closure of the stoma via partial primary closure with intervening silver dressing using Aquacel® Ag compared with PC group. The silver dressings used in this study incorporate ionic silvercontaining Hydrofiber dressing (Aquacel® Ag) was provided by ConvaTec. None of the investigators have any interests in the company providing the silver dressings. Patients were assessed pre-operatively, during the admission for operation, at 2 weeks for SSI and at 6 weeks for wound healing. Twenty-four patients were sampled into the control group and 20 patients in the study group. The mean age for both control and study groups was between 53 years old. The gender in both the groups was predominantly male. The type of stoma of both groups was predominantly colostomy.When evaluating other variables with regard to surgical site infection, none was found to be statistically significant in increasing the risk of infection. There were two patients (8 %) of the SSI rate in the control group but zero in the study group. The healing rate was 100 % in the study group as compared to 92 % in the control group. However, both SSI and healing rate were not statically significant in this comparative study. * N. H. Zubaidah dr.zubaidahnh@gmail.com
Databáze: OpenAIRE
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