0.05% Chlorhexidine Gluconate Irrigation in Trauma/Emergency General Surgical Laparotomy Wounds Closure: A Pilot Study

Authors

James A. Zebley, Department of Surgery, Center for Trauma and Critical Care, George Washington University, Washington, District of Columbia.
Andrea Klein, Department of Surgery, Center for Trauma and Critical Care, George Washington University, Washington, District of Columbia.
Karen Wanersdorfer, Department of Surgery, Center for Trauma and Critical Care, George Washington University, Washington, District of Columbia.
Megan T. Quintana, Department of Surgery, Center for Trauma and Critical Care, George Washington University, Washington, District of Columbia.
Babak Sarani, Department of Surgery, Center for Trauma and Critical Care, George Washington University, Washington, District of Columbia.
Jordan M. Estroff, Department of Surgery, Center for Trauma and Critical Care, George Washington University, Washington, District of Columbia.
Susan Kartiko, Department of Surgery, Center for Trauma and Critical Care, George Washington University, Washington, District of Columbia. Electronic address: skartiko@mfa.gwu.edu.

Document Type

Journal Article

Publication Date

1-1-2024

Journal

The Journal of surgical research

Volume

293

DOI

10.1016/j.jss.2023.09.016

Keywords

Acute care surgery; Irrisept; Surgical site infection; Wound closure

Abstract

INTRODUCTION: Patients who undergo exploratory laparotomy (EL) in an emergent setting are at higher risk for surgical site infections (SSIs) compared to the elective setting. Packaged Food and Drug Administration-approved 0.05% chlorhexidine gluconate (CHG) irrigation solution reduces SSI rates in nonemergency settings. We hypothesize that the use of 0.05% CHG irrigation solution prior to closure of emergent EL incisions will be associated with lower rates of superficial SSI and allows for increased rates of primary skin closure. METHODS: A retrospective observational study of all emergent EL whose subcutaneous tissue were irrigated with 0.05% CHG solution to achieve primary wound closure from March 2021 to June 2022 were performed. Patients with active soft-tissue infection of the abdominal wall were excluded. Our primary outcome is rate of primary skin closure following laparotomy. Descriptive statistics, including t-test and chi-square test, were used to compare groups as appropriate. A P value <0.05 was statistically significant. RESULTS: Sixty-six patients with a median age of 51 y (18-92 y) underwent emergent EL. Primary wound closure is achieved in 98.5% of patients (65/66). Bedside removal of some staples and conversion to wet-to-dry packing changes was required in 27.3% of patients (18/66). We found that most of these were due to fat necrosis. We report no cases of fascial dehiscence. CONCLUSIONS: In patients undergoing EL, intraoperative irrigation of the subcutaneous tissue with 0.05% CHG solution is a viable option for primary skin closure. Further studies are needed to prospectively evaluate our findings.

APA Citation

Zebley, James A.; Klein, Andrea; Wanersdorfer, Karen; Quintana, Megan T.; Sarani, Babak; Estroff, Jordan M.; and Kartiko, Susan, "0.05% Chlorhexidine Gluconate Irrigation in Trauma/Emergency General Surgical Laparotomy Wounds Closure: A Pilot Study" (2024). GW Authored Works. Paper 3516.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/3516

Department

Surgery