Electronic Thesis and Dissertation Repository

Thesis Format

Monograph

Degree

Master of Science

Program

Surgery

Supervisor

Dubois, Luc

Abstract

Introduction: Arterial surgery using a groin incision has a high incidence of surgical site infection (SSI), which is morbid and costly. Gentamicin-eluting collagen sponges and vancomycin powder are effective SSI prophylaxis for nonvascular operations. Feasibility of a prospective trial of SSI incidence after high-risk arterial surgery with topical gentamicin and vancomycin was assessed.

Methods: A randomized controlled feasibility trial enrolling 32 patients with ≥1 of obesity, diabetes, reoperation, tissue loss or dialysis. In 41 groin incisions, 21 had standard closure and 20 had closure with topical gentamicin and vancomycin. Primary feasibility outcomes and secondary clinical outcomes were recorded at 90 days.

Results: Feasibility was achieved in all metrics. SSI was reported in 13 patients (31.7%), 8 (38.1%) standard and 5 (25.0%) experimental patients.

Conclusion: Gentamicin-eluting collagen sponge and vancomycin powder use in high-risk groin incisions is feasible for study. There was a trend towards fewer infections in the experimental arm.

Summary for Lay Audience

Operations performed by vascular surgeons commonly involve groin incisions to expose the femoral arteries. Infection in these incisions, known as surgical site infections (SSI), are common and occur much more often than after other types of surgery. Certain patients, such as obese patients, diabetic patients, renal failure patients on dialysis, patients having a redo surgery or who have tissue loss from poor blood flow are at especially high-risk of developing SSI. SSI in a groin incision after a vascular operation is usually treated with antibiotics, as well as opening and packing the wound with a dressing until it heals from the bottom up. In some cases, SSI can require reoperation or even amputation of the surgical limb because of infection involving the recently operated blood vessel or associated graft (fabric tube sewn to a hole in the artery). SSI cause additional discomfort for the patient and are costly to the healthcare system. There are few strategies that are effective in preventing groin incision SSI after vascular surgery. Different surgeons, such as cardiac and orthopaedic surgeons, have shown antibiotics placed in the surgical incision prior to closure can prevent SSI. We are interested in assessing whether placing a gentamicin-eluting collagen sponge and vancomycin powder in the incision prior to closure prevents SSI in high-risk patients. We conducted a feasibility study to determine whether such a study could practically be performed.

We recruited 32 patients with 41 groin incisions who had at least one major risk factor for groin SSI. We randomly assigned 21 to the usual method of groin incision closure and 20 to the topical gentamicin and vancomycin group on a per-groin basis. We found the study to be feasible in all aspects. SSI developed in 31.7% or 13 of the 41 groin incisions. Eight of 21 patients in the standard closure group, or 38.1%, and 5 of 20 in the topical antibiotics group, or 25.0%, developed SSI. The difference between the groups was 13.1%. Using these results, we plan to carry out a full-scale study to assess if gentamicin-eluting collagen sponges combined with vancomycin powder prevent SSI.

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