Abstract: Objective:To investigate the application value of continuous irrigation and vacuum suction by subcutaneous drainage tube for prevention of abdominal type Ⅳ incision infection.
Methods:A prospective, singleblind, randomized, controlled study was conducted based on the clinical data of 123 patients with abdominal type Ⅳ incision infection who were admitted to the First People′s Hospital of Foshan between January 2008 and July 2014. Patients were divided into the experimental group and the control group based on the random number table and received open surgery. Patients in the experimental group were placed subcutaneous drainage tube with postoperative continuous irrigation and vacuum suction, while patients in the control group adopted the method of traditional abdominal closure without subcutaneous drainage tube. The levels of preoperative hemoglobin (Hb) and albumin (Alb), severity grading according to the American Society of Anesthetheologists (ASA), levels of Hb and Alb at postoperative day 1, 3, 7 were recorded and postoperative incision infection and bacteria culture were observed. Patients received biweekly regular return visit by outpatient evamination after discharged up to 3 months after suture removal. Measurement data with normal distribution were presented as ±s and comparison between groups was analyzed by t test. Measurement data with skew distribution were presented as M (Qn) and comparison between groups were analyzed by rank sum test. Repeated measures data were analyzed by the repeated measures ANOVA. Count data were analyzed by the chisquare test.
Results:One hundred and twentythree patients were screened for eligibility, and 65 were allocated into the experimental group and 58 into the control group. The levels of Hb and Alb at postoperative day 1, 3, 7 were (111±15)g/L, (107±18)g/L, (108±13)g/L and 30 g/L(26 g/L,32 g/L), 31 g/L(28 g/L,33 g/L), 35 g/L(32 g/L,37 g/L) in the experimental group and (112±13)g/L, (106±16)g/L, (106±12)g/L and 30 g/L(25 g/L,32 g/L), 32 g/L(29 g/L,33 g/L), 37 g/L (32 g/L,38 g/L) in the control group, with no significant difference in the changing trends of the above indexes between the 2 groups (F=0.124, 0.007, P>0.05). There were 4 patients with incision infection in the experimental group and 12 patients in the control group, showing a significant difference (χ²=2.723, P<0.05). The infections occurred at postoperative 4-6 days confined to subcutaneous tissues and unreached to muscular and below layers, and then were cured by incision open drainage without recurrence. Patients without incision infection were removed the stitches at postoperative 7-9 days. Incision bacteria cultures showed that Escherichia coli was detected in 8 cases (including 1 complicated with Enterococcus faecalis and 1 complicated with Klebsiella pneumonia and Pseudomonas aeruginosa), Pseudomonas aeruginosa in 1 case, Klebsiella pneumonia in 2 cases, Acinetobacter baumanii in 1 case, Enterobacter cloacae in 1 case and no bacteria in 3 cases. All the patients were followed up for 3 months after incision healing and survived well without recurrence and complications such as incision split and incision fistula.
Conclusion:Continuous irrigation and vacuum suction by subcutaneous drainage tube can be operated easily and effectively reduce the postoperative infection rate in abdominal type Ⅳ incision .