Antiseptic wick: Does it reduce the incidence of wound infection following appendectomy?

Abstract

The role of prophylactic antibiotics is well established for contaminated wounds, but the use of antiseptic wound wicks is controversial. The aim of this work was to study the potential use of wound wicks to reduce the rate of infection following appendectomy. This prospective randomized controlled clinical trial was conducted at a university hospital in the department of surgery. The subjects were patients undergoing appendectomy for definite acute appendicitis. They were randomized by computer to primary subcuticular wound closure or use of an antiseptic wound wick. For the latter, ribbon gauze soaked in povidone-iodine was placed between interrupted nylon skin sutures. Wicks were soaked daily and removed on the fourth postoperative day. All patients received antibiotic prophylaxis. They were reviewed while in hospital and 4 weeks following operation for evidence of wound infection. The main outcome measures were wound infection, wound discomfort, and cosmetic result. The overall wound infection rate was 8.6% (15/174). In patients with wound wicks it was 11.6% (10/86) compared to 5.6% (5/88) in those whose wounds were closed by subcuticular sutures (p = NS). We concluded that the use of wound wicks was not associated with decreased wound infection rates following appendectomy. Subcuticular closure is therefore appropriate in view of its greater convenience and safety.

Wound infection prophylaxis in pediatric acute appendicitis: a 26-year prospective study

“…To a lesser degree (and maybe with the same rationale), the results were similar in the few studies reported over the last 40 years, which involved a subcutaneous wound drain [3]. Surprisingly, however, a wound pack (or wick) between a few loosely placed skin sutures bwas not associated with decreased wound infection rates following appendectomyQ in adults [4]. In our group 2 of 96 patients with a subcutaneous drain or pack only, we also did not see any improvement in the wound infection rate when compared with no treatment (group 1) (Table 1).…”

“…Although most articles in the literature (both adult and pediatric) indicate that some form of antibiotic prophylaxis will diminish the incidence of wound infection after appendectomy for both acute and ruptured appendicitis [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20], some authors still claim prophylaxis makes no difference [4,21,22].…”

“…The wound Penrose drain [3] or one half-inch gauze pack [4] and/or antibiotic powder [5][6][7][8][9][10][11][12] (ampicillin, 1977-1981; cefoxitin 1982-1995) were all placed in the subcutaneous space. If the infant or child was allergic to penicillin, no antibiotic powder was placed in the wound and intravenous clindamycin (or metronidazole) and gentamicin were used.…”

Uso de iodóforo tópico em feridas agudas

“…Quanto à prevenção de infecção com o uso de iodóforos (Grupo IV), a taxa de infecção obtida foi maior no grupo tratado com PVP-I comparativamente ao grupo controle (18) .…”

Open appendectomy for pediatric ruptured appendicitis: a historical clinical review of the prophylaxis of wound infection and postoperative intra-abdominal abscess

“…5,[9][10][11][12][14][15][16][17][18] Although some reports (both adult and pediatric, often combined) indicate that some form of antibiotic prophylaxis will diminish the incidence of both complications, 35,[37][38][39][40][41][42][43][44][45][46][47][48][49][50] others claim it makes no difference. 5,23,24,[27][28][29][30][31][32][33]36,[51][52][53][54] In our series, each ruptured appendix at operation had an obvious perforation confirmed by histopathological examination. The amount of peritoneal contamination varied between a small localized area in the right lower quadrant (15%) and gross contamination throughout the peritoneal cavity (85%).…”