Arch Surg Chicago
-
Randomized Controlled Trial Comparative Study Clinical Trial
The influence of hair-removal methods on wound infections.
The influence of preoperative shaving v clipping on wound infection rate was studied in 1,013 patients undergoing elective operations at a single hospital. Patients were prospectively randomized to be either shaved or clipped the night before or the morning of operation. ⋯ For each 1,000 patients treated, a savings of approximately $270,000 could be realized if the AM clipper method replaced shaving for preoperative hair removal. Preoperative shaving is deleterious, and the practice should be abandoned.
-
Within a 24-month period, 454 patients were admitted with burns (average size, 33% of the total body surface [TBS]). Wound infection developed in 19, who subsequently were treated with subeschar antibiotics. The average burn size in those 19 patients was 63% of the TBS, with an average full-thickness injury of 47%. ⋯ The five surviving patients (average burn size, 59% TBS) underwent excision of infected tissue, with split-thickness cutaneous autograft closure of the burn wound, after the course of subeschar antibiotic infusion. All surviving patients were infected with Pseudomonas aeruginosa. Subeschar infusion of semisynthetic penicillins, therefore, is an effective adjunct in the care of the patient with Pseudomonas burn-wound infection.
-
Opsonic fibronectin modulates reticuloendothelial (RE) uptake of nonbacterial particulates, as well as some bacterial strains, and may thus play an important role in host defense against sepsis after burn injury. We evaluated the relationship between burn injury, sepsis, and opsonic fibronectin levels in rats, as well as the ability to reverse the acute opsonic deficiency after burn injury by administration of purified opsonic fibronectin. ⋯ The in vitro serum opsonic deficit was partially correctable (from 2.2% to 6.7% of the injected dose per 100 mg), while in vivo RE functional deficits could not be corrected. We conclude that the acute postburn deficiency in opsonic fibronectin is amenable to repletion therapy; however, many additional factors may contribute to acute RE failure after burn injury.