Bacterial biofilms on implanted suture material are a cause of surgical site infection.

BACKGROUND: Surgical site infection (SSI) has been estimated to occur in up to 5% of all procedures, accounting for up to 0.5% of all hospital costs. Bacterial biofilms residing on implanted foreign bodies have been implicated as contributing or causative factors in a wide variety of infectious scenarios, but little consideration has been given to the potential for implanted, submerged suture material to act as a host for biofilm and thus serve as a nidus of infection. METHODS: We report a series of 15 patients who underwent open Roux-en-Y gastric bypass (with musculofascial closure with permanent, multifilament sutures) who developed longstanding and refractory SSIs in the abdominal wall. Explanted suture material at subsequent exploration was examined for biofilm with confocal laser-scanning microscopy (CLSM) and fluorescence in situ hybridization (FISH). RESULTS: All 15 patients at re-exploration were found to have gross evidence of a "slimy" matrix or dense reactive granulation tissue localized to the implanted sutures. Confocal laser-scanning microscopy revealed abundant biofilm present on all sutures examined; FISH was able to identify the presence of specific pathogens in the biofilm. Complete removal of the foreign bodies (and attendant biofilms) resulted in all cases in cure of the SSI. CONCLUSION: Bacterial biofilms on implanted suture material can manifest as persistent surgical site infections that require complete removal of the underlying foreign body substrata for resolution.

Secondary surgery for cicatricial complications of facial injury.

PURPOSE: To investigate the nature of surgical revision procedures necessitated by cicatricial complications of facial injury. PATIENTS AND METHODS: All patients who had facial trauma in a period of approximately 5 years managed by a single surgeon were reviewed. Of these, 36 were found to have undergone secondary revision procedures arising specifically from scar-related complications. RESULTS: The average age of patients undergoing revision surgery was 34 years; 27 of the 36 patients (75%) were men, and 9 of the 36 (25%) required multiple revision surgical visits. The most common cause of injury was motor vehicle collision; the interval between the initial trauma and the first revision surgery was most commonly 6 to 12 months. Scar-related complications were categorized on the face by anatomic subsite; they occurred most frequently on the forehead/cheeks/chin area, with the eyes/periorbital area the second most frequent location. One hundred twelve discrete surgical procedures (as per current procedural terminology) were performed on these 36 patients to address the cicatricial sequelae of their initial injuries. CONCLUSIONS: Facial trauma can frequently entail secondary morbidity in the form of facial scar deposition, which itself can necessitate surgical repair. This represents a substantial but as yet underappreciated health care burden attendant to maxillofacial injury.