Contaminated Wounds: Infection Rates With Subcutaneous Sutures, ,

Study objective: To determine whether buried absorbable subcutaneous sutures (BASS) increase the infection rate in irrigated contaminated wounds. Methods: 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 108 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). Results: 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. Conclusion: BASS increase the infection rate and the degree of inflammation in contaminated wounds, despite thorough irrigation. [Mehta PH, Dunn KA, Bradfield JF, Austin PE: Contaminated wounds: Infection rates with subcutaneous sutures. Ann Emerg Med January 1996;27:43-48.]