Prospective analysis of postoperative wound infections using an early exposure method of wound care

The management of operative wounds in most surgical procedures is important in preventing many complications, most notably, infection. Among most surgical subspecialties, postsurgical dressings vary in type of materials utilized as well as duration left in place. The authors propose that the contemporary method of postoperative wound management (i.e., dressings left in place until sutures are removed) is overly conservative when dealing with the uncomplicated patient population. This study involves 100 patients who underwent forefoot, rearfoot, or ankle procedures in which skin incisions were made on nonweightbearing surfaces and percutaneous pins, external fixators, or casts were not utilized. All wounds were considered clean and patients displayed an uncomplicated medical history. Postoperatively, the patients were treated by an early exposure method (i.e., the wounds were left undressed on the 4th postoperative day and patients were allowed to bathe in their usual manner). Patients returned on postoperative day 10-14 at which time sutures were removed. Wounds were inspected up to 12 weeks following surgery. An infected wound was defined by the presence of cellulitis or lymphangitis or by the secretion of purulence from the incision line. The incidence of wound infection was 1.0%. This study also includes analysis via questionnaire of the postoperative care utilized by 495 randomly selected diplomates of the American Board of Podiatric Surgery as well as the surgery department chairs at the seven podiatric medical colleges.