Delayed infection following axillary shoulder incisions

Area of Science:

• Orthopedic Surgery
• Infectious Disease
• Surgical Site Infections

Background:

• Postoperative shoulder infections typically present earlier than in other joints.
• Delayed infections, especially those presenting over six months after surgery, are uncommon.
• This study focuses on rare instances of delayed infection following shoulder surgery via axillary incisions.

Purpose of the Study:

• To report and analyze unusual cases of delayed postoperative infection after shoulder surgery using axillary incisions.
• To highlight the importance of considering infection in patients with delayed symptoms.

Main Methods:

• A retrospective chart review was conducted for patients undergoing shoulder surgery via axillary incisions between 2013 and 2021.
• Data were collected from 378 surgical procedures performed by two surgeons.
• Infection cases were identified and analyzed for presentation timing and outcomes.

Main Results:

• Four cases of infection were identified among 378 surgeries performed via axillary incisions over a nine-year period.
• All identified infections presented with significant delay, ranging from 7 to 32 months postoperatively.
• All patients successfully resolved their infections after surgical treatment.

Conclusions:

• High clinical suspicion for infection is crucial in patients with surgical site pain after axillary incision shoulder surgery, even with delayed presentation.
• Arthroscopic techniques may be a viable alternative to minimize infection risk where appropriate.
• Thorough debridement and removal of foreign materials during surgical intervention are key to preventing recurrent infections.