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Advances in the treatment of large soft-part defect wounds
Abstracts
217
with peritonitis due to p e r f o r a t e d diverticulitis or carcinoma. O f the 23 w o u n d s packed open due to i n t r a - a b d o m i n a l sepsis Escherichia coli was c u l t u r e d in 18, Bacteroidesfragilis in six a n d p e p t o s t r e p t o c o c c u s in four. All were sterile in 5 days w h i c h t h e n allowed closure. No w o u n d infections were r e c o r d e d in 187 operations t r e a t e d with p r i m a r y closure. * Any communication should be addressed to: 6382 West North Avenue, Chicago, IL 60635, USA.
Povidone-iodine 10% i s o t o n i c s o l u t i o n ('Betadine' irrigating solution) a n d i n f e c t i o n in g e n e r a l s u r g i c a l w o u n d s G. H a i g Hammett Square, Tiverton, Devon E X 1 6 6LR Fifty-eight patients received a p o v i d o n e - i o d i n e ( P V P - I ) 10% solution w o u n d wash d u r i n g operation and 68 received a saline w o u n d wash. Patients were e x a m i n e d for w o u n d infection and for systemic evidence of infection at 3 and 7 days and 1 m o n t h postoperatively. A variety of operations were p e r f o r m e d , including operations for a b d o m i n a l t u m o u r s , varicose veins, a n d operations involving the h a n d s and feet, h e r n i o r r h a p h y a n d others. O f the patients receiving P V P - I no bacteria were s u b s e q u e n t l y isolated from t h e i r w o u n d s and 13 patients h a d evidence of w o u n d infection. I n the saline group, 17 patients yielded bacteria from t h e i r w o u n d s a n d 40 patients developed a p p e a r a n c e s of w o u n d infection. T h e s e results were c o n f i r m e d by the clinical i m p r e s s i o n that patients treated with P V P - I experienced less postoperative w o u n d discomfort and t h e i r w o u n d s healed more cleanly. In a few cases the different w o u n d t r e a t m e n t s were used at two operation sites in the same patient, and in these cases t h e r e s e e m e d to be less pain a n d swifter healing in the w o u n d receiving P V P - I at operation.
A d v a n c e s in the t r e a t m e n t of large soft-part d e f e c t w o u n d s H. D. Brose Staedt. Krankenhaus Norderstadt, Haltenhoffstrasse 41, 3000 Hanover, West Germany Various t r e a t m e n t r e g i m e n s and m a n y topical p r e p a r a t i o n s based on different active principles are suggested for the after-care of large soft-part wounds. In this study, p o v i d o n e iodine ( P V P - I ) lavage followed by a silicone e l a s t o m e r basic p o l y m e r i m p l a n t was used (Wood & Hughes, 1975; W o o d , Williams & H u g h e s , 1977; K i p p i n g , H e i d & M c G r e g g o r , 1982). D u r i n g a 7 - m o n t h period, 22 patients (20 males and two females; m e a n age 28.5 years) with large soft-part defect w o u n d s after surgery have b e e n treated. T h e s e consisted of 16 soft tissue defects after excision of pilonidal sinus, four defect w o u n d s after removal of a l t h e r o m a and two abscesses. O n the second p o s t o p e r a t i v e day, w o u n d lavage was carried o u t with N a C I / P V P - I a n d the w o u n d cavity was filled w i t h a silicone e l a s t o m e r basic p o l y m e r implant. In each case two i m p l a n t s were prepared. T h e r e a f t e r , a regular change of dressing w i t h change of silicone elastomer i m p l a n t was m a d e every 8-12 h, d e p e n d i n g on the c o n d i t i o n of the w o u n d . T h e i m p l a n t was renewed a p p r o x i m a t e l y every 3~1- days a n d P V P - I lavage was c o n t i n u e d until infection-free w o u n d healing was obtained.
218
Abstracts
T h i s was achieved in all cases. In two cases from the patient g r o u p o p e r a t e d on for pilonidal sinus a relapse o c c u r r e d after 6 - 7 m o n t h s necessitating a second operation. C h a n g e of dressing was tolerated well by o u r patients, a n d n e i t h e r adhesions of dressing material to w o u n d s n o r intolerance or allergic reactions to the materials used have b e e n observed. W o u n d healing was achieved after approximately 28-7 days. N o c h a n g e of t r e a t m e n t was required in any of the patients.
References Kipping, F. F., Heid, J. F. & M c G r e g g o r , R. R. (1982). Selastic foam dressing. Dow
Corning, Scientific Brochure. Wood, R. A. B. & H u g h e s , L. E. (1975). Silicone foam s p o n g e for pilonidal sinus. A new t e c h n i q u e for dressing open g r a n u l a t i n g wounds. British Medical Journal 4, 131-133. Wood, R. A. B., Williams, R. H. P. & Hughes, L. E. (1977). F o a m e l a s t o m e r dressing in the m a n a g e m e n t of open g r a n u l a t i n g wounds. E x p e r i e n c e with 250 patients. British Journal of Surgery 64, 554-557.
T h e effects o f v a g i n a l a n t i s e p s i s a n d s u r g e r y u p o n t h e e n d o c e r v i c a l b a c t e r i a l flora o f w o m e n u n d e r g o i n g t e r m i n a t i o n o f p r e g n a n c y M . S t e w a r t , P. L u t h r a & S. S l a t e r S t . George's Hospital, L o n d o n Little is k n o w n of the natural history of the endocervical bacterial flora at t e r m i n a t i o n of pregnancy, and its significance. W e report here some p r e l i m i n a r y findings of a s t u d y examining this flora. O n e - h u n d r e d - a n d - f o u r consecutive w o m e n r e q u e s t i n g t e r m i n a t i o n b e t w e e n 6 and 12 weeks gestation were recruited to the study. Endocervical swabs were taken u n d e r direct vision via a sterile s p e c u l u m from 96 w o m e n at the first clinic visit (swab 1 ), in t h e a t r e p r i o r to antiseptic p r e p a r a t i o n from 64 w o m e n (swab 2), at conclusion of the o p e r a t i o n (swab 3), and 2 weeks later f r o m 48 w o m e n in the follow-up clinic (swab 4). Horse blood agar, chocolate agar, blood agar and cysteine, blood agar h a e m i n , cysteine and neomycin, M a c C o n k e y , T h a y e r M a r t i n , 5 % h u m a n blood agar and S a b o u r a u d plates were variously i n c u b a t e d anaerobically, in elevated C O 2 or aerobically. Patients with t r i c h o m o n i a s i s at any stage of the s t u d y were excluded f r o m analysis leaving 90 w o m e n (swab 1), 59 w o m e n (swabs 2 and 3), and 46 w o m e n (swab 4). T h e aerobic and anaerobic p o p u l a t i o n s f o u n d on swab I were similar to those r e p o r t e d for other groups of p r e g n a n t w o m e n (Hurley et al, 1974) a n d were similar to those on swab 2 and swab 4. T h e r e was an excess of aerobic organisms f o u n d in w o m e n aged 21 25 years. Preoperative vaginal a n d cervical antisepsis significantly r e d u c e d the endocervical flora b u t a mean of 1 "73 species per w o m a n was still found at c o n c l u s i o n of the operation. N o difference in effect could be d e m o n s t r a t e d between the use of p o v i d o n e - i o d i n e and c h l o r h e x i d i n e solutions. Recolonization of the endocervix was complete at 2 weeks. No patient at follow-up had clinical evidence of infection. T h e s e findings suggest that pre-operative vaginal a n d cervical antisepsis is less effective than imagined at disinfecting the lower female genital tract. T h e y f u r t h e r cast d o u b t on the value of p r e - o p e r a t i v e bacteriological assessment of the cervix and the clinical significance of positive cultures from the endocervix.
Reference Hurley, R., Stanley, V., Leask, B. G. S. & De Louvois, J. (1974) The normal microbialflora of man (Skinner, F. A. & Carr, J. G., Eds) A c a d e m i c Press: L o n d o n .
217
with peritonitis due to p e r f o r a t e d diverticulitis or carcinoma. O f the 23 w o u n d s packed open due to i n t r a - a b d o m i n a l sepsis Escherichia coli was c u l t u r e d in 18, Bacteroidesfragilis in six a n d p e p t o s t r e p t o c o c c u s in four. All were sterile in 5 days w h i c h t h e n allowed closure. No w o u n d infections were r e c o r d e d in 187 operations t r e a t e d with p r i m a r y closure. * Any communication should be addressed to: 6382 West North Avenue, Chicago, IL 60635, USA.
Povidone-iodine 10% i s o t o n i c s o l u t i o n ('Betadine' irrigating solution) a n d i n f e c t i o n in g e n e r a l s u r g i c a l w o u n d s G. H a i g Hammett Square, Tiverton, Devon E X 1 6 6LR Fifty-eight patients received a p o v i d o n e - i o d i n e ( P V P - I ) 10% solution w o u n d wash d u r i n g operation and 68 received a saline w o u n d wash. Patients were e x a m i n e d for w o u n d infection and for systemic evidence of infection at 3 and 7 days and 1 m o n t h postoperatively. A variety of operations were p e r f o r m e d , including operations for a b d o m i n a l t u m o u r s , varicose veins, a n d operations involving the h a n d s and feet, h e r n i o r r h a p h y a n d others. O f the patients receiving P V P - I no bacteria were s u b s e q u e n t l y isolated from t h e i r w o u n d s and 13 patients h a d evidence of w o u n d infection. I n the saline group, 17 patients yielded bacteria from t h e i r w o u n d s a n d 40 patients developed a p p e a r a n c e s of w o u n d infection. T h e s e results were c o n f i r m e d by the clinical i m p r e s s i o n that patients treated with P V P - I experienced less postoperative w o u n d discomfort and t h e i r w o u n d s healed more cleanly. In a few cases the different w o u n d t r e a t m e n t s were used at two operation sites in the same patient, and in these cases t h e r e s e e m e d to be less pain a n d swifter healing in the w o u n d receiving P V P - I at operation.
A d v a n c e s in the t r e a t m e n t of large soft-part d e f e c t w o u n d s H. D. Brose Staedt. Krankenhaus Norderstadt, Haltenhoffstrasse 41, 3000 Hanover, West Germany Various t r e a t m e n t r e g i m e n s and m a n y topical p r e p a r a t i o n s based on different active principles are suggested for the after-care of large soft-part wounds. In this study, p o v i d o n e iodine ( P V P - I ) lavage followed by a silicone e l a s t o m e r basic p o l y m e r i m p l a n t was used (Wood & Hughes, 1975; W o o d , Williams & H u g h e s , 1977; K i p p i n g , H e i d & M c G r e g g o r , 1982). D u r i n g a 7 - m o n t h period, 22 patients (20 males and two females; m e a n age 28.5 years) with large soft-part defect w o u n d s after surgery have b e e n treated. T h e s e consisted of 16 soft tissue defects after excision of pilonidal sinus, four defect w o u n d s after removal of a l t h e r o m a and two abscesses. O n the second p o s t o p e r a t i v e day, w o u n d lavage was carried o u t with N a C I / P V P - I a n d the w o u n d cavity was filled w i t h a silicone e l a s t o m e r basic p o l y m e r implant. In each case two i m p l a n t s were prepared. T h e r e a f t e r , a regular change of dressing w i t h change of silicone elastomer i m p l a n t was m a d e every 8-12 h, d e p e n d i n g on the c o n d i t i o n of the w o u n d . T h e i m p l a n t was renewed a p p r o x i m a t e l y every 3~1- days a n d P V P - I lavage was c o n t i n u e d until infection-free w o u n d healing was obtained.
218
Abstracts
T h i s was achieved in all cases. In two cases from the patient g r o u p o p e r a t e d on for pilonidal sinus a relapse o c c u r r e d after 6 - 7 m o n t h s necessitating a second operation. C h a n g e of dressing was tolerated well by o u r patients, a n d n e i t h e r adhesions of dressing material to w o u n d s n o r intolerance or allergic reactions to the materials used have b e e n observed. W o u n d healing was achieved after approximately 28-7 days. N o c h a n g e of t r e a t m e n t was required in any of the patients.
References Kipping, F. F., Heid, J. F. & M c G r e g g o r , R. R. (1982). Selastic foam dressing. Dow
Corning, Scientific Brochure. Wood, R. A. B. & H u g h e s , L. E. (1975). Silicone foam s p o n g e for pilonidal sinus. A new t e c h n i q u e for dressing open g r a n u l a t i n g wounds. British Medical Journal 4, 131-133. Wood, R. A. B., Williams, R. H. P. & Hughes, L. E. (1977). F o a m e l a s t o m e r dressing in the m a n a g e m e n t of open g r a n u l a t i n g wounds. E x p e r i e n c e with 250 patients. British Journal of Surgery 64, 554-557.
T h e effects o f v a g i n a l a n t i s e p s i s a n d s u r g e r y u p o n t h e e n d o c e r v i c a l b a c t e r i a l flora o f w o m e n u n d e r g o i n g t e r m i n a t i o n o f p r e g n a n c y M . S t e w a r t , P. L u t h r a & S. S l a t e r S t . George's Hospital, L o n d o n Little is k n o w n of the natural history of the endocervical bacterial flora at t e r m i n a t i o n of pregnancy, and its significance. W e report here some p r e l i m i n a r y findings of a s t u d y examining this flora. O n e - h u n d r e d - a n d - f o u r consecutive w o m e n r e q u e s t i n g t e r m i n a t i o n b e t w e e n 6 and 12 weeks gestation were recruited to the study. Endocervical swabs were taken u n d e r direct vision via a sterile s p e c u l u m from 96 w o m e n at the first clinic visit (swab 1 ), in t h e a t r e p r i o r to antiseptic p r e p a r a t i o n from 64 w o m e n (swab 2), at conclusion of the o p e r a t i o n (swab 3), and 2 weeks later f r o m 48 w o m e n in the follow-up clinic (swab 4). Horse blood agar, chocolate agar, blood agar and cysteine, blood agar h a e m i n , cysteine and neomycin, M a c C o n k e y , T h a y e r M a r t i n , 5 % h u m a n blood agar and S a b o u r a u d plates were variously i n c u b a t e d anaerobically, in elevated C O 2 or aerobically. Patients with t r i c h o m o n i a s i s at any stage of the s t u d y were excluded f r o m analysis leaving 90 w o m e n (swab 1), 59 w o m e n (swabs 2 and 3), and 46 w o m e n (swab 4). T h e aerobic and anaerobic p o p u l a t i o n s f o u n d on swab I were similar to those r e p o r t e d for other groups of p r e g n a n t w o m e n (Hurley et al, 1974) a n d were similar to those on swab 2 and swab 4. T h e r e was an excess of aerobic organisms f o u n d in w o m e n aged 21 25 years. Preoperative vaginal a n d cervical antisepsis significantly r e d u c e d the endocervical flora b u t a mean of 1 "73 species per w o m a n was still found at c o n c l u s i o n of the operation. N o difference in effect could be d e m o n s t r a t e d between the use of p o v i d o n e - i o d i n e and c h l o r h e x i d i n e solutions. Recolonization of the endocervix was complete at 2 weeks. No patient at follow-up had clinical evidence of infection. T h e s e findings suggest that pre-operative vaginal a n d cervical antisepsis is less effective than imagined at disinfecting the lower female genital tract. T h e y f u r t h e r cast d o u b t on the value of p r e - o p e r a t i v e bacteriological assessment of the cervix and the clinical significance of positive cultures from the endocervix.
Reference Hurley, R., Stanley, V., Leask, B. G. S. & De Louvois, J. (1974) The normal microbialflora of man (Skinner, F. A. & Carr, J. G., Eds) A c a d e m i c Press: L o n d o n .