[Prevention of wound infection following abdominal surgery]

In the surgical department described, prevention of wound infection after abdominal operations involving endogenous bacterial contamination consists of a single preoperative administration of antibiotics according to a simple scheme, suitable for nursing staff also (using a combination of amoxicillin, tobramycin or metronidazole) with liberal application of open wound treatment. During the period from 1 July 1985 to 1 July 1986, 519 abdominal operations were performed, classified by increasing degree of contamination according to the classification of the American National Research Council (NRC) as NRC classes II to IV. In 371 cases, the wound was closed (NRC class II: 285; NRC class III: 86). In 148 cases (40%) the wound was intentionally left open (NRC class III: 51; NRC class IV: 97). In the group with NRC class II only two wound infections were seen. Inter alia there were no infections after 141 gall bladder/biliary tract operations, none after 46 gastrectomies and only one after 54 elective colon resections. In the group with NRC class III with 86 closed wounds, no wound infections occurred. All 148 wounds left open (NRC classes III and IV) healed smoothly, without significant morbidity, prolonged hospital stay or increase of the number of out-patient follow-up visits; moreover, the cosmetic results were good. With specific antimicrobial prophylaxis in a single administration combined with liberal open-wound treatment, postoperative wound infection after laparotomy appears to be virtually controlled.