Contaminated wounds: infection rates with subcutaneous sutures.

Abstract

To determine whether buried absorbable subcutaneous sutures (BASS) increase the infection rate in irrigated contaminated wounds. This was a randomized, prospective trial in a rat model, with the histologist blinded to treatment group. A single 2-cm dorsal incision was made on each of 30 anesthetized 250-g Sprague-Dawley rats and inoculated with approximately 10(8) organisms of Staphylococcus aureus. After irrigation, 15 wounds were closed with running 4-0 nylon transdermal sutures, and 15 were closed with three interrupted 4-0 coated polyglactin 910 (Vicryl) subcuticular sutures (BASS) and running 4-0 nylon transdermal sutures. On day 7, wounds were scored on a scale of 0 to 3 in six categories: inflammatory infiltrates, fibroplasia and capillary proliferation, necrosis, exudates, giant cells, and edema. The possible range for the cumulative wound score was 0 (no inflammation) to 18 (severe inflammation and infection). The median total wound score in wounds closed with BASS was 14 (range, 7 to 16); it was 8 (range, 5 to 15) for wounds closed without BASS (P = .0004). The subscores for inflammation, necrosis, exudate, and edema were also significantly higher in wounds closed with BASS. BASS increase the infection rate and the degree of inflammation in contaminated wounds, despite through irrigation.