Management of contaminated and dirty surgical wounds with different local treatment modalities

Abstract

Between March and November 1986 we studled 216 men with potentially infected surgical wounds (either contaminated or diny). For the purpose of local treatment they were allocated to one of 4 groups, namely: 1) pressure irrigation with saline solution; 2) lodo-povidone solution; 3) application of panela (unrefined brown sugar); 4) no local treatment. infection indexes were 18% and 25% in patients with contaminated and diny wounds respectively; no differences attributable to the local treatment procedure were found. infection index was significantly lower In the following circumstances: a) In patients that received antibiotics both before and after the operation; b) In those with culture results that were either negative or lower than 105 bacteria per gram of tissue.

Frequency of positive wound cultures was significantly lower in patients with saline pressure irrigation as compared to those treated with panela or left without treatment. However, the frequency of clinical evidences of infection was similar In the 4 groups. In patients with negative cultures late primary closure was achieved in 95% of the cases; the corresponding figure for those with positive results (but under 105 bacteria per gram) was 56%. We conclude that pressure Irr1gatlon of the wound with saline solution is advantageous in relation to the other methods employed in this study.