Proposed Classification of Incision Complications: Analysis of a Prospective Study on Elective Open Lower-Limb Revascularization

Abstract

Background: Incision complications (IC) have a significant impact on procedure-related morbidity after lowerlimb revascularization. One of the most studied IC is surgical site infection (SSI). Reporting these complications in a uniform way is crucial to evaluate treatment approaches. The aim of this study was to propose a comprehensive classification of IC and apply it to compare SSI with other IC in a trial on elective open lowerlimb revascularization procedures. Methods: Two hundred twenty-three eligible patients undergoing elective unilateral inguinal and infra-inguinal arterial vascular surgery were extracted from a randomized controlled trial on incisional negative-pressure wound therapy (NPWT) on inguinal vascular surgical incisions. The IC were classified by grades of severity (grade 0-6) that focused on IC-related consequences such as out-patient treatment (grade 1), prolonged inpatient treatment (grade 2), re-admission (grade 3), and re-operation (grade ‡4). An SSI was defined by the ASEPSIS score criteria. Results: An SSI was diagnosed in 63 patients (28.3%). Thirty-five of 160 patients (21.8%) not suffering from SSI underwent IC treatment. Treatment for IC was recorded for 25/144 patients (17.4%) with satisfactory site healing as judged by the ASEPSIS score. The median incision-related in-hospital stay in those with SSI (n = 79) and disturbed healing (n = 16) according to the ASEPSIS score was 13 days in both groups (p = 0.53). Five patients had peri-vascular SSI (IC grade 4 n = 4; grade 5 n = 1). The proposed classification of IC and the ASEPSIS score correlated highly (r = 0.77; p < 0.001). Inter-rater reliability for IC grading was substantial for three investigators with different levels of experience (k = 0.81, 0.71, and 0.70). Conclusions: The proposed incision classification suggests a comparable clinical significance of vascular IC in terms of IC-related in-patient stay, whether there was a surgical site infection or not. This classification system requires external validation.

Negative Pressure Wound Therapy for the Prevention of Surgical Site Infections Using Fascia Closure After EVAR—A Randomized Trial

“…Identified SSIs were also graded according to the Szilagyi classification: grade 1 (involving dermis), grade 2 (involving subcutaneous tissue), or grade 3 (involving vascular prosthesis) [ 14 ]. The wound complications, both SSIs and other wound complications, were also graded according to an incisional wound complication scale [ 15 ].…”

Ultrasound Mediated Polymerization for Cell Delivery, Drug Delivery, and 3D Printing

“…Other risks in such invasive procedures may include infections, nerve injuries, and periphery tissues damage at the operated site. [10][11][12][13] To partly overcome these issues, several approaches have been developed in recent years including injection of cell suspension, cell-laden beads, or cellularized shape memory injectable scaffolds. [14][15][16] Yet, these methods are limited in construct size and shape, or with minimal control over material and cell distribution in the target location.…”

“…Other risks in such invasive procedures may include infections, nerve injuries, and periphery tissues damage at the operated site. [ 10–13 ]…”