A Case of Tension Subcutaneous Emphysema Treated With Minimally Invasive Open-Window Thoracostomy Using a Wound Protector/Retractor and Three-Sided Taping.

Subcutaneous emphysema is a common complication of thoracic surgery. Tension subcutaneous emphysema that causes airway obstruction is rare but life-threatening. This report presents a patient who developed tension subcutaneous emphysema after recurrent secondary pneumothorax surgery which was treated with minimally invasive open-window thoracostomy. A wound protector/retractor and three-sided taping were successfully used to prevent air from entering the subcutaneous space via the wound while draining trapped air without creating an open pneumothorax. This approach is an option for managing subcutaneous and intrathoracic air leakage in emergency situations.

Effect of wound protectors in reducing the incidence of surgical site wound infection in lower gastrointestinal surgery: A meta-analysis.

We performed a meta-analysis to evaluate the effect of wound protectors in reducing the incidence of surgical site wound infection in lower gastrointestinal surgery. A systematic literature search up to June 2022 was performed and 6026 subjects with lower gastrointestinal surgery at the baseline of the studies; 3090 of them were using the wound protector, and 2936 were using no wound protector. Odds ratio (OR) with 95% confidence intervals (CIs) were calculated to assess the effect of wound protectors in reducing the incidence of surgical site wound infection in lower gastrointestinal surgery using the dichotomous methods with a random or fixed-effect model. The surgical site wound infection was significantly lower with single-ring wound protectors (OR, 0.53; 95% CI, 0.39-0.83, P = .004), and dual-ring wound protectors (OR, 0.44; 95% CI, 0.35-0.56, P < .001) in subjects with lower gastrointestinal surgery compared with no wound protector. The surgical site wound infection was significantly lower with single-ring wound protectors, and dual-ring wound protectors in subjects with lower gastrointestinal surgery compared with no wound protector. The analysis of outcomes should be with caution because of the low sample size of 5 out of 28 studies in the meta-analysis and a low number of studies in certain comparisons.

Role of single or double ringed circumferential wound protectors in reducing surgical site infections following colorectal resections. A systematic review.

Objective: The objective of this article is to explore whether the use of single or double ringed wound protectors (WP) in patients undergoing colorectal resection (CRR) are associated with reduced risk of surgical site infections (SSI). Materials and methods: Analysis was conducted according to PRISMA guidelines. With the help of expert local librarians, systematic search of medical databases like MEBASE, MEDLINE and PubMed was conducted to find appropriate randomized controlled trials (RCT) according to predefined inclusion criteria. The analysis of the pooled data was done using the principles of meta-analysis on statistical software RevMan version 5. Result: Twelve RCT on 2425 patients fulfilled the inclusion criteria. There were 1216 patients in the WP group and 1209 patients in the no-WP group. In the random effects model analysis, the use of WP during CRR was associated with the reduced risk of SSI [odds ratio 0.60, 95% CI (0.41-0.90), z = 2.49, P = 0.01]. However, there was significant heterogeneity (Tau2 = 0.22; Chi2 = 25.87, df = 11; (p = 0.007; I2 = 57%) among included studies. Conclusion: Use of WP seems to reduce the risk of SSI and therefore, may routinely be used during both open and laparoscopic CRR.

The effect of intraoperative wound protector use on the risk of surgical site infections in patients undergoing pancreatoduodenectomy: a systematic review and meta-analysis.

AIMS: To evaluate the effect of intraoperative wound protectors on the risk of surgical site infection (SSI) in patients undergoing pancreatoduodenectomy. METHODS: In compliance with PRISMA statement standards, electronic databases were searched to identify all studies comparing wound protector use with no wound protector use in patients undergoing pancreatoduodenectomy. SSI (superficial or deep) was considered primary outcome measure. The secondary outcome measures included superficial SSI, deep SSI, and organ-space SSI. Random effects modelling was applied to calculate pooled outcome data. The certainty of evidence was assessed using GRADE system. RESULTS: A total of 12159 patients from four studies were included. The included populations in both groups were comparable in terms of baseline characteristics. The use of wound protector was associated with lower risk of superficial or deep SSI (OR: 0.55, 95% CI 0.43-0.70, P<0.00001), superficial SSI (OR: 0.59, 95% CI 0.46-0.76, P<0.0001), and organ-space SSI (OR: 0.80, 95% CI 0.72-0.90, P=0.0002). There was no difference between the two groups in terms of the risk of deep SSI (OR: 0.68, 95% CI 0.43-1.06, P=0.09) although this may be subject to type 2 error. CONCLUSIONS: The results of current study suggests that the use of intraoperative wound protector during pancreatoduodenectomy may reduce the risk of postoperative SSI. The quality of the available evidence is moderate with high certainty. While evidence from future randomised controlled trials could increase the robustness of our conclusions, we do not hesitate to recommend the use of wound protectors during pancreatoduodenectomy based on the current evidence.

Impact of a Dual-Ring Wound Protector on Outcome After Elective Surgery for Colorectal Cancer.

BACKGROUND: The impact of dual-ring wound protectors (DRWPs) on the long-term outcomes of patients with colorectal cancer (CRC) undergoing elective surgery remains unclear. The aim of this cohort study was to compare short- and long-term outcomes after CRC resection with or without use of a DRWP. METHODS: This study enrolled 625 patients with stage I-III CRC undergoing curative resection and divided them into DRWP (n = 348) and control (n = 277) groups. Primary endpoints were postoperative short- and long-term complications. Secondary endpoints were oncological outcomes including wound recurrence, disease-free survival, and overall survival. RESULTS: Rates of postoperative complications (P = 0.004) and laparotomy wound infection (LWI) (P < 0.001) were markedly lower in the DRWP group. Operation quality, as per the number of lymph nodes harvested and rate of R0 resection, did not differ between the groups (all P > 0.05). The DRWP group exhibited significantly lower rates of incisional hernia occurrence (5.3% versus 9.5%, P = 0.045) compared with the control group. Multivariable analyses demonstrated an increased risk of LWI with no wound protector in colorectal surgery (odds ratio, 3.778; P = 0.001), and patients who developed LWI after surgery were more than 4 times more likely to develop an incisional hernia during outpatient follow-up (odds ratio, 4.333; P = 0.001). One patient in the control group (0.36%) had isolated wound recurrence at 12 mo postoperatively. CONCLUSIONS: Fewer postoperative and late complications, comparable oncological safety, and similar long-term clinical outcomes confirmed the benefits of DRWP use for patients with CRC undergoing elective surgery. Therefore, the use of DRWP may be considered in curative CRC resection.

Prevalence and predictors of surgical site infections after bowel resection for Crohn's disease: the role of dual-ring wound protector.

PURPOSE: Surgical site infections (SSIs) have become a leading cause of preventable morbidity and mortality in surgery. The aim was to evaluate the efficacy of a dual-ring wound protector to prevent the SSIs in Crohn's disease (CD) after bowel resection. METHODS: This retrospective observational study included all CD patients undergoing bowel resection at the Inflammatory Bowel Disease Center between January 2015 and June 2018 at Sir Run Run Shaw Hospital. Risk factors of SSIs were evaluated by assessing preoperative clinical characteristics and perioperative treatments in univariate and multivariate analyses. Outcomes for CD patients with and without the wound protector were compared. RESULTS: Three hundred forty-four CD patients were enrolled in this study, 121 (35.2%) patients had postoperative complications, of whom, 72 (20.9%) patients developed SSIs (12.8% patients with incisional SSI and 8.1% patients with organ/space SSI). There was a significant reduction in the incidence of incisional SSI in the wound protector group (8.1% vs 16.8%, p < 0.05). No significant differences were identified in organ/space SSI between groups with and without wound protector (6.3% vs 9.8%, p = 0.232). Incisional SSI correlated with preoperative albumin, C-reactive protein, white blood cell, age (≤ 16), penetrating disease behavior, surgical history, open surgery, stoma creation, estimated blood loss, infliximab, and wound protector (p < 0.05). Multivariate analysis identified the wound protector to be one of independent factors for preventing incisional SSIs (OR 0.357, 95% CI 0.161-0.793, p < 0.05). CONCLUSION: Among the CD patients with bowel resection, the use of a dual-ring wound protector during surgery significantly reduced the risk of incisional SSI.

O-Ring Protector in Prevention of SSIs in Laparoscopic Colorectal Surgery.

BACKGROUND: Surgical-site infections (SSIs) remain a serious complication of colorectal surgery, causing a significant financial burden to the health care system. The aim of this study is to investigate whether the use of an O-ring retractor can be effective in preventing the incidence of wound infections after elective laparoscopic colorectal surgery. METHODS: A retrospective case-control study from January 2014 to June 2018 was performed. Data were analyzed from a retrospective colorectal database. SSI was defined according to criteria published by the European Centre for Disease Prevention and Control and analyzed as a primary outcome. RESULTS: Three hundred twelve consecutive patients (n = 312) were enrolled in our study. Among them, 158 patients (Group A) in which an O-ring retractor device was used during surgery was compared with a control group of 154 patients (Group B) in which an O-ring retractor device was not used. Primary outcome was to determine SSIs rates among the 2 groups. No statistically differences were observed with regard to baseline characteristics between both groups. A total of 9 patients (5.69%) and 24 (15.58%) with SSIs were identified in Group A and B, respectively, and the difference was statistically significant (OR, 0.32; 95% CI, 0.14-0.72; P = .0045). The median postoperative hospital stay length was 6.7 days in group A and 7.6 days in group B (P ≤ .05). CONCLUSIONS: SSIs infections rates were significantly higher in patients in which an O-ring retractor device was not used. This study suggests that the use of a wound protector device can be considered for routine use in elective colorectal surgery.

Minimizing Propionibacterium acnes contamination in shoulder arthroplasty: use of a wound protector.

BACKGROUND: Propionibacterium acnes may be transmitted from the subdermal tissues to the deeper tissues during shoulder arthroplasty surgery, resulting in deep infection. The aim of this prospective, clinical study was to determine whether the use of a wound protector drape can lower the incidence of P. acnes in the wound during shoulder arthroplasty surgery. METHODS: For a consecutive series of 47 patients undergoing shoulder arthroplasty, a wound protector drape was used during surgery, to isolate the subdermal layer from the surgeons' hands, retractors and other instruments. Microbiological swabs were taken both from the subdermal layer and the exposed drape to determine the incidence of P. acnes at both sites. RESULTS: The overall incidence of P. acnes in the subdermal layer was 23%. A fivefold decrease in the incidence of P. acnes in the exposed superficial layer was demonstrated by use of the wound protector drape. CONCLUSION: Use of a wound protector drape to isolate the superficial tissue layer from the surgeons' gloves, instruments and retractors decreases the incidence of P. acnes in the surgical field. This may result in a decreased rate of transmission to the deeper tissues, and a decreased rate of P. acnes deep infection.

Dual Ring Wound Protector Reduces Circular Stapler Related Surgical Site Infections in Patients Undergoing Laparoscopic Roux-En-Y Gastric Bypass.

BACKGROUND: While there are various techniques to create the gastrojejunostomy during a laparoscopic Roux-en-Y gastric bypass (LRYGB), many surgeons prefer using a circular stapler. One drawback of this method, however, is the higher incidence of surgical site infections (SSIs). To investigate the effect of a dual ring wound protector on SSIs during LRYGB. METHODS: In April 2016, our bariatric surgical group implemented an intervention whereby a dual ring wound protector in conjunction with a conical EEA stapler introducer was used when creating the gastrojejunostomy. SSIs from pre- and post-intervention were compared using Fisher's exact test. Only LRYGBs performed with a circular stapler were included in our analysis. Student's t test and χ2 were used to compare pre- and post-intervention groups with respect to demographics and co-morbidities. RESULTS: Between April 2015 and January 31st, 2017, our surgeons performed 158 LRYGBs using a circular stapler for the gastrojejunostomy. There were 84 patients (53%) in the pre-intervention group and 74 (47%) in the post-intervention group. The pre- and post-intervention groups were not statistically different. The SSI rate for the pre-intervention group was 9.5% while the SSI rate was 1.35% in the post-intervention group (p = 0.0371). The use of a dual ring wound protector for LRYGBs with circular stapled gastrojejunostomy was associated with an 86% relative risk reduction in SSIs. CONCLUSION: Using a dual ring wound protector in conjunction with a conical EEA introducer for LRYGBs with circular stapled gastrojejunostomy significantly decreased SSIs.

The Efficacy of a Novel Surgical Device in Preventing Intraoperative Wound Contamination in an In Vivo Porcine Model.

BACKGROUND: Surgical site infections (SSIs) remain a morbid and costly complication in abdominal surgery. Topical antibiotic delivery via intraoperative irrigation and barrier wound protection are strategies for preventing SSI. We tested the safety and efficacy of a novel wound protector device with an integrated fluid irrigation platform in a porcine model. METHODS: A simulated colorectal resection model was designed and performed on adult female pigs with a standardized concentration of 109 colony-forming units (CFU) of Escherichia coli administered to the wound site in 10 mL of normal saline (n = 7). The device was tested intraoperatively with and without irrigation with gentamicin-containing irrigant solution. Swab and tissue samples were obtained in addition to peripheral blood samples. Quantitative culture analysis was performed in addition to histological and immunohistochemical analysis and gentamicin concentration measurements. RESULTS: There were no adverse events observed in the animals. Tissue protected by the device yielded exponentially lower levels of E. coli growth compared to exposed tissue, with a mean 1 × 102 CFU/swab. Use of the device, both with and without irrigation, was associated with an exponential reduction in quantitative bacterial load compared to the control wounds with no device, with limited growth after wound closure in the pigs receiving irrigation. Histology and terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) staining analysis revealed no significant damage to tissue. Serum gentamicin levels remained below the clinical threshold and decreased over time. CONCLUSIONS: This in vivo study suggests safety and efficacy of a novel device for the prevention of intraoperative wound contamination.

Are wound ring protectors effective in reducing surgical site infection post appendectomy? A systematic review and meta-analysis.

INTRODUCTION: Surgical site infection (SSI) is one of the main causes of postoperative morbidity and mortality. Appendectomy for acute appendicitis is one of the most commonly performed surgical interventions worldwide. The use of ring retractors to protect the wound edge from contaminated intra-abdominal contents may be an effective method to reduce SSI. AIM: The aim of this systematic review and meta-analysis is to determine whether the use of wound ring retractors reduces SSI rates after open appendectomy. METHODS: A systematic review of randomized controlled trials (RCTs) and meta-analysis of ring retractors was undertaken using the PRISMA guidelines. PubMed, Cochrane RCTs Central Register, CINAHL, and ISRCTN registry were searched for eligible studies. Only studies in which open appendectomy was undertaken were included. The Cochrane Collaboration's RevMan 5.3 was used for analysis. A subgroup analysis by degree of appendiceal inflammation was performed. RESULTS: Four RCTs inclusive of 939 patients met eligibility requirements. One trial used single ring while three used double ring protectors. Differences in the definition of SSI, skin preparation, and type and duration of prophylactic antibiotic were found between the 4 studies. The use of ring retractors show some evidence of SSI reduction risk ratio 0.44 [95 % CI (0.21, 0.90)]. On sub-analysis, ring retractor was more effective in more severe degrees of appendiceal inflammation i.e., the contaminated group. CONCLUSION: Our review suggests some benefit in using ring retractors to reduce SSI post appendectomy; however the small number and variable quality of the studies suggest the need for more RCTs to confirm these results.

Effect of wound protector on preventing incisional wound infection following class Ⅲ-Ⅳincision abdominal operation / 中国感染控制杂志

Objective To evaluate the effect of wound protector on preventing incisional wound infection following class Ⅲ-Ⅳincision abdominal operation.Methods Patients who had undergone class Ⅲ-Ⅳincision abdominal opera-tion from January 2013 to December 2014 were divided into trial group and control group according to whether they had used wound protector ,incidence of postoperative incisional wound infection between two groups were com-pared.Results A total of 310 patients were monitored,150 cases in trial group,and 160 cases in control group. Incidence of incisional wound infection in trial group was significantly lower than control group (4.00% [n=6]vs 11 .88%[n=19],χ2 =6.48,P <0.05).The average operation time and length of hospital stay in trial group were both shorter than control group ([42.10±3.30]min vs [58.30±4.10]min,P <0.05;[7.00±2.20]d vs [10.00 ±3.50]d ,P <0.05),score of pain assessment of incision in trial group was lower than control group([2.00 ± 1 .70]vs [3.00±1 .80],P <0.05).Conclusion Wound protector can effectively reduce the incidence of incisional wound infection following class Ⅲ-Ⅳincision abdominal operation.

Effect of Operative Wound Protection on Surgical Wound Complications

PURPOSE: Surgical wound complications remain a cause of morbidity and mortality among postoperative patients, and the cost of caring for patients with a surgical wound complication is substantial. The purpose of this study was to evaluate the ability of a vinyl wound protector to reduce the rate of wound complications when used in clean-contaminated surgery. MATERIALS AND METHODS: Between May 2006 and September 2006, 295 patients with a gastric cancer that underwent gastric surgery were studied prospectively, and the patients were randomized into one of two groups: the no wound protector group (n=137) or the polyethylene protector group (n=132). RESULTS: The demographics and operation type and operation time were similar for patients in both groups. The rate of wound complication was different between patients in the no protector group (n=42) and the polyethylene protector group (n=12) (P=0.001) and the rates of seroma (P=0.001), infection (P=0.030) and dehiscence (P=0.282) were different for the two groups. The postoperative hospital stay was significantly shorter in the polyethylene protector group of patients (P=0.040). CONCLUSION: The use of a polyethylene protector resulted in a reduction of the surgical wound complication rate, and the cost of caring for patients, and morbidity and mortality among postoperative patients could be reduced.