hold together for a
long time, such as
tendons. Absorbable
sutures that can take
up to six months to
dissolve are also
available, he says.
The closing meth-
ods your surgeons
use must be strong
enough to completely
close each layer of
the wound until it's
completely healed.
"Infection prevention
really starts at the
deeper tissue layers,"
says Jon Minter, DO,
an orthopedic sur-
geon in Alpharetta,
Ga., who specializes
in advanced surgical
management of hip
and knee arthritis.
"And some of the
sutures available now
are antibactericidal,
which are fantastic
because they inhibit
bacterial growth."
Another key com-
ponent of wound care
is proper irrigation. "The classic statement is, 'the
solution to pollution is dilution,'" says Dr. Minter.
"Irrigation of the wound is part of the continuum of
care in most surgical cases because foreign debris or
planktonic bacteria can be removed through the use
of irrigating solutions."
Irrigating the wound during a layered closure is
vital to flush out any bacteria debris; otherwise, the
bacteria will pool and create an abscess and an
infection. For these reasons, Dr. Minter suggests a
standard approach to wound irrigation should be
considered for even the most routine surgical pro-
cedures as part of an overall antisepsis care
program in the OR.
"We're seeing
enhancement in some
of the wound irrigates
that are available," he
notes. "They're key in
terms of reducing
infection, which is
going to allow for
greater healing."
Dr. Regulski also
praises the benefits of
proper wound irriga-
tion. "In the old days,
we used saline, which
has no effect on bac-
teria or biofilm, or a
diluted betadine solu-
tion, which is toxic to
healing cells and
bone tissue," he
explains. "Newer irri
-
gating options
destroy biofilm,
which is resistant to
so many things, with-
out harming good tis-
sue. So, you can irri-
gate the wound as
you're completing a
layered closure to
prevent infections in
high-risk patients."
In addition to closing technique and irrigation,
applying wound gel and sterile adherent dressings
to the incision helps to prevent bacteria from get-
ting in. "A lot of the dressings we use now are silver
impregnated, which are very inhibitory to bacteria,
so we apply them to create a sterile environment,"
says Dr. Minter. "We'll leave them on our outpatient
hip and knee patients for five to seven days, and by
that time the wound has healed up quite nicely.
These dressings also allow patients to shower with-
out getting the wound wet."
A permanent reminder
No patient goes into surgery hoping they leave with
1 6 • S U P P L E M E N T
T O O U T P A T I E N T S U R G E R Y M A G A Z I N E • M A R C H 2 0 2 1
WOUND WATERING A standard approach to irrigation should be considered for even the most rou-
tine surgical procedures as part of an overall care program of antisepsis in the OR.
University
of
Massachusetts
Medical
School
