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Original Article
April 2011April 18, 2011

Significant Reduction of Wound Infections With Daily Probing of Contaminated Wounds: A Prospective Randomized Clinical Trial

Author Affiliations

Author Affiliations: Departments of Surgery, Cedars-Sinai Medical Center, Los Angeles, California (Drs Towfigh and Pooli), University of Southern California, Los Angeles (Drs Clarke, Mason, Katkhouda, and Berne), and Washington University, St Louis, Missouri (Dr Yacoub).

Arch Surg. 2011;146(4):448-452. doi:10.1001/archsurg.2011.61

Hypothesis  Local wound management using a simple wound-probing protocol (WPP) reduces surgical site infection (SSI) in contaminated wounds, with less postoperative pain, shorter hospital stay, and improved patient satisfaction.

Design  Prospective randomized clinical trial.

Setting  Academic medical center.

Patients  Adult patients undergoing open appendectomy for perforated appendicitis were enrolled from January 1, 2007, through December 31, 2009.

Interventions  Study patients were randomized to the control arm (loose wound closure with staples every 2 cm) or the WPP arm (loosely stapled closure with daily probing between staples with a cotton-tipped applicator until the wound is impenetrable). Intravenous antibiotic therapy was initiated preoperatively and continued until resolution of fever and normalization of the white blood cell count. Follow-up was at 2 weeks and at 3 months.

Outcome Measures  Wound pain, SSI, length of hospital stay, other complications, and patient satisfaction.

Results  Seventy-six patients were enrolled (38 in the WPP arm and 38 in the control arm), and 49 (64%) completed the 3-month follow-up. The patients in the WPP arm had a significantly lower SSI rate (3% vs 19%; P = .03) and shorter hospital stays (5 vs 7 days; P = .049) with no increase in pain (P = .63). Other complications were similar (P = .63). On regression analysis, only WPP significantly affected SSI rates (P = .02). Age, wound length, body mass index, abdominal circumference, and diabetes mellitus had no effect on SSI. Patient satisfaction at 3 months was similar (P = .69).

Conclusions  Surgical site infection in contaminated wounds can be dramatically reduced by a simple daily WPP. This technique is not painful and can shorten the hospital stay. Its positive effect is independent of age, diabetes, body mass index, abdominal girth, and wound length. We recommend wound probing for management of contaminated abdominal wounds.