Atraumatic Technic—The Sine Qua Non of Operative Wound Infection Prophylaxis

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CAN postoperative wound infections be avoided? A positive “yes” in answer to this question would relieve the surgeon of a great burden. It would eliminate physical discomfort and financial hardship for the patient, and it would abolish what has become a new source of litigation in the courts.

The incidence of postoperative wound infection has been reported to be from 1.0 to 37.0 per cent.1–9 The 2.0 per cent infection rate reported by Meleney and Johnson7 is used as the standard rate for clean cases. During the past year, in 1,248 consecutive operative procedures performed on the plastic surgery service of the Cleveland Clinic Hospital, only one wound infection occurred, an incidence of about 0.08 per cent. The infection occurred in a patient who had undergone a combined laryngectomy and radical neck procedure.

We believe that postoperative wound infections can be almost completely eliminated by the rigid application of sound surgical principles. The antibiotic era, however, has fostered a relaxation of these principles. The purpose of this paper is to outline the principles that we have found to be successful in the prevention of postoperative wound infection.

Conditions for Wound Infection

Three factors constitute the cycle that leads to wound infection (Fig. 1); they are, in the order of increasing importance: (1) a receptive host, (2) contaminating organisms, and (3) a wound culture medium that acts as pabulum for the bacteria. This cycle can be broken by eliminating any one of the three factors, and a wound infection thereby . . .



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