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Effect of postoperative wound infection on the course of stage II melanoma.

Microbial infections reportedly have a favorable effect on the course of certain malignant diseases. Intralesional inoculation of micro-organisms can bring about tumor regression in certain clinical and experimental situations. In order to evaluate the influence of immediate postoperative wound infection on the course of Stage II melanomas, a retrospective study was undertaken of 211 patients who had undergone axillary or groin dissection. None had any antibiotic, steroid, chemoimmunotherapy, or cryosurgery and there was no history of a second primary neoplasm, pregnancy, immunodeficiency, or administration of immunosuppressive drugs. Forty of these patients developed significant postoperative wound infections. Although their representation according to sex, tumor location, number of nodes involved, and other parameters was comparable to that of the remaining 171 patients who did not develop wound infections, the incidence of local recurrence in the group with infections was significantly lower (p less than 0.01). Patient survival and disease-free interval following node dissection were not influenced by infection. Postoperative infections in the groin or axilla offered only local protection from tumor recurrence; the ultimate course of the disease was not affected.

Escherichia coli Infections

Contamination with enterobacteria and postoperative wound infection after appendicectomy.

The impact of contamination on wound infections was investigated in 120 patients undergoing appendicectomy for appendicitis. A quantitative sample for culture of enterobacteria was obtained from the subcutaneous wound with the velvet pad imprint technique. Average number of enterobacteria (CFU) in the would was 1.2 logarithms higher in operations for gangrenous appendices and 2.3 logarithms higher in perforated appendices compared to flegmonous appendices. Infection rate was 2.5% in flegmonous, 10% in gangrenous and 27.5% in perforated appendices. The results focus the close relation between contamination and subsequent infection.

Appendectomy

Prevention of wound infection in abdominal operations by peroperative antibiotics or povidone-iodine. A controlled trial.

The wound-infection rate after abdominal operations was compared in 113 patients randomly allocated to an untreated control group, a group receiving preoperative lincomycin and tobramycin, or a group receiving local instillation of povidone-iodine. The wound-infection rate was 8.1% in 37 patients receiving antibiotics, 42.1% in 38 untreated controls, and 39.5% in 38 patients in the povidone-iodine group.

Abdomen

Povidone-iodine: an adjunct in the treatmen of wound infections, dehiscences, and fistulas in head and neck surgery.

Extensive research has been done to elucidate the cellular and biochemical events of a healing wound. Similarly, new techniques are continually being investigated which would stimulate and augment the reparative process. This paper describes the uses and biochemistry of povidone-iodine which has gained widespread acceptance as a surgical preparation. However, its use as a topical agent for treating head and neck wound infections, dehiscences, and salivary fistulas has gained little recognition. Povidone-iodine is a unique compound formed by binding free iodine to polyvinylpyrrolidone. Previously, the toxic effects of iodine limited its use to preparation of the skin for surgery. When bound to the pyrrolidine molecule, iodine becomes water soluble and markedly less toxic. As a result, the broad antimicrobial spectrum of iodine may be used topically to control wound sepsis. It can be applied to mucosal surfaces without producing burns. The brown color acts as an indicator of its clinical effectiveness. When the dressings become light yellow or pale, free iodine is no longer being released and the dressing should be changed. Povidone-iodine is not a panacea for correcting interruption in the healing process during the postoperative period. The basic management of wound infections, dehiscences, and fistulas remains unchanged. Incision and drainage, debridement and flap contracture, lateralization, and diversion are necessary to initiate the healing process. Familarity with each phase of healing provides the basis for managing each of these surgical problems. Topical povidone-iodine not only controls wound sepsis but augments wound healing. The physiologic correlation with each phase of wound healing for these various surgical problems is elaborated and clinical cases presented.

Administration, Topical

A new principle for the cleansing of infected wounds.

When dry porous hydrophilic beads, formed by a three dimensional network of dextran polymers, are placed on a discharging wound, they absorb the exudate and swell to form of a gelatinous layer. Within this gelatinous layer a separation of substances occurs according to their molecular weights, with the smaller (MW less than 1000) freely penetrating the pores of the beads and the larger (MW greater than 5 000) remaining in the interspaces. Since proteins are removed from the wound surface with the fluid, crustformation on the wound is prevented. Clotting within the gel layer does not occur, since, as shown in another study (Aberg, Hedner, Jacobsson & Rothman 1976), wound exudate contains a high amount of fibrin-fibrinogen split products and no coagulable fibrinogen. Therefore as long as dry beads are available, exudate can be sucked up. With the wound exudate bacteria, degradation products and toxins are removed from the wound surface. A substance with the above described properties Debrisan (Pharmacia AB, Sweden) was used to treat various types of wounds. The treatment was most effective for profusely discharging infected wounds. Within a few days inflammation subsided, exudate decreased and granulation tissue appeared. So far no side effects are observed and even patients, who during years of treatment of leg ulcers had become sensitized to most dressings and local antibiotics could be treated. The new technique for sampling of wound fluid also offers a model for studies on inflammatory mediators and protein loss.

Administration, Topical

The clinical importance of anaerobic bacteria in wound infections after gastrointestinal surgery.

Wound cultures from 54 patients with infections after gastrointestinal surgery were examined. Cultures from wounds after surgery on the upper gastrointestinal tract grew few organisms, mainly aerobic gram-positive cocci. Culture from wounds on the lower gastrointestinal tract grew strains of bacteria, aerobic and anaerobic gram-negative rods dominating. Indirect immunofluorescence studies on acute and convalescent phase sera showed significant immune response against Bacteroides fragilis in a majority of cases. Immune response against anaerobic cocci was seldom found. Very high antibody titres against Clostridium perfringens were often found, both in patients' and control sera.

Adolescent

Wound infections after colectomy.

The records of 650 patients were analyzed to determine factors predisposing the patients to wound infections. Statistically significant increases in infections were found in association with Crohn's disease, stomas present preoperatively, serum albumin levels of less than 2.9 g/dl, operative blood losses greater than 1,200 ml or operative times longer than two hours, preoperative irradiation, and bowel preparations other than mechanical preparation and nonabsorbable antibiotics. Wound infection did not occur in patients who were prepared for the operation with the neomycin-erythromycin antibiotic regimen.

Anti-Bacterial Agents