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Surgical factors in the prevention of infection following major lower limb amputation

J E Coulston1, V Tuff, C P Twine

  • 1Department of Vascular Surgery, Musgrove Park Hospital, Taunton, United Kingdom. jamescoulston@yahoo.co.uk

European Journal of Vascular and Endovascular Surgery : the Official Journal of the European Society for Vascular Surgery
|February 21, 2012
PubMed
Abstract

Insights

Surgical drains and skin clips increase infection risk after major lower limb amputation. Avoiding these techniques can reduce post-operative wound infections in amputation surgery.

Area of Science:

  • Surgical outcomes
  • Infectious disease

Background:

  • Post-operative infection is a common complication following major lower limb amputation.
  • The specific surgical factors influencing infection rates remain unclear.

Purpose of the Study:

  • To evaluate the impact of peri-operative surgical factors on infection rates in patients undergoing major lower limb amputation.

Main Methods:

  • Prospective database review of 127 patients undergoing lower limb amputation (March 2008 - July 2010).
  • Infection classified using Centre for Disease Control (CDC) criteria.
  • Multivariate analysis to identify significant risk factors for post-operative infection.

Main Results:

  • 34.6% of patients developed a wound infection.
  • Higher infection rates observed in below-knee compared to above-knee amputations.
  • Use of suction drains and skin clips (versus sutures) were associated with increased infection rates (p < 0.05).
  • No significant relationship found between surgeon grade, peri-operative antibiotics, operation length, or nerve catheter use and infection rates.

Conclusions:

  • Suction drains and skin clips are identified as surgical factors that adversely affect the risk of infection in major limb amputations.
  • Recommendations include avoiding the use of skin clips and suction drains to minimize infection risk.

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