Gentamicin Ointment versus Petrolatum for Management of Auricular Wounds

Abstract

BACKGROUND. Surgeons frequently create defects on the ear in the treatment of cutaneous malignancies. Potentially significant complications of second-intention healing on the ear are suppurative and inflammatory chondritis. Consequently, many physicians advocate the use of oral or topical prophylactic antibiotics after auricular surgery.OBJECTIVE. The purpose of this study is to compare the efficacy of gentamicin ointment with that of petrolatum for the prevention of suppurative chondritis during second-intention healing of auricular wounds after Mohs surgery. METHODS. One hundred forty-two patients with a total of 147 second-intention wounds were prospectively selected to receive either gentamicin ointment or petrolatum postoperatively. RESULTS. One hundred forty-four wounds were evaluated in a follow-up examination or by telephone interview. Eight (5.56%) wounds developed suppurative chondritis. Four wounds received gentamicin and four received petrolatum, for incidences of 4.76% and 6.67%, respectively. Twelve (8.33%) other wounds developed inflammatory chondritis. Ten (11.90%) received gentamicin and two (3.33%) received petrolatum.CONCLUSIONS. There is no statistically significant difference between the use of gentamicin ointment and petrolatum in the prevention of postoperative auricular suppurative chondritis. The data also demonstrate a disproportionate number of cases of inflammatory chondritis in the gentamicin-treated group. This study supports the cost-effective and potentially less irritating use of petrolatum for wound care in this difficult to manage area.

Stoma care products represent a common and previously underreported source of peristomal contact dermatitis

“…), constituted the other major group of products (Table 1). In addition, products from various manufacturers elicited positive reactions, and their ingredients are shown in Table 1 (13)(14)(15)(16)(17)(18)(19)(20)(21).…”

“…Product testing was performed either as a use test or a patch test. In most patients (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15), the use test was employed, as the product being tested is normally either applied and then occluded under adhesive dressings or is the adhesive dressing itself. For the use test, we identified an area of uninvolved skin of ∼10 cm 2 on which to apply the product.…”

Is Levofloxacin Necessary to Prevent Postoperative Infections of Auricular Second-Intention Wounds?

“…8 Two more recent studies found slightly lower rates of complication, with 5.6% to 8.33% of patients experiencing inflammatory chondritis and 0% to 5.56% of patients experiencing suppurative chondritis. 2,7 These higher rates of complication in auricular surgery have been attributed to extensive manipulation of the auricular cartilage 2,7 and colonization of moist tissue with higher bacterial counts. 8 P. aeruginosa is a particular concern because it has been implicated in infections after surgical manipulation, ear piercing, and acupuncture.…”

“…It also supports findings of a previous study, which showed that second-intention healing for auricular wounds has a low incidence of infection. 7 Reconstructed auricular wounds have demonstrated a higher incidence of infection and may warrant prophylactic antibiotics. 8 A 1-week course of 500 mg of levofloxacin daily is estimated to cost $70.…”

“…[2][3][4] Oral quinolones may be used due to their excellent skin and soft tissue penetration in addition to their anti-Pseudomonas activity. 5,6 A recent study demonstrated no advantage of postoperative topical antibiotics over petrolatum in preventing auricular infections, 7 but the efficacy of postoperative prophylactic oral antibiotics has not yet been evaluated.…”