Wound photography for evaluation of surgical site infection and wound healing after lower limb trauma

Abstract

Aims Deep surgical site infection (SSI) is common after lower limb fracture. We compared the diagnosis of deep SSI using alternative methods of data collection and examined the agreement of clinical photography and in-person clinical assessment by the Centers for Disease Control and Prevention (CDC) criteria after lower limb fracture surgery. Methods Data from two large, UK-based multicentre randomized controlled major trauma trials investigating SSI and wound healing after surgical repair of open lower limb fractures that could not be primarily closed (UK WOLLF), and surgical incisions for fractures that were primarily closed (UK WHiST), were examined. Trial interventions were standard wound care management and negative pressure wound therapy after initial surgical debridement. Wound outcomes were collected from 30 days to six weeks. We compared the level of agreement between wound photography and clinical assessment of CDC-defined SSI. We are also assessed the level of agreement between blinded independent assessors of the photographs. Results Rates of CDC-defined deep SSI were 7.6% (35/460) after open fracture and 6.3% (95/1519) after closed incisional repair. Photographs were obtained for 77% and 73% of WOLLF and WHiST cohorts respectively (all participants n = 1,478). Agreement between photographic-SSI and CDC-SSI was fair for open fracture wounds (83%; k = 0.27 (95% confidence interval (CI) 0.14 to 0.42)) and for closed incisional wounds (88%; k = 0.29 (95% CI 0.20 to 0.37)) although the rate of photographically detected deep SSIs was twice as high as CDC-SSI (12% vs 6%). Agreement between different assessors for photographic-SSI (WOLLF 88%, k = 0.63 (95% CI 0.52 to 0.72); WHiST 89%; k = 0.61 (95% CI 0.54 to 0.69)); and wound healing was good (WOLLF 90%; k = 0.80 (95% CI 0.73 to 0.86); WHiST 87%; k = 0.57 (95% CI 0.50 to 0.64)). Conclusion Although wound photography was feasible within the research context and inter-rater assessor agreement substantial, digital photographs used in isolation overestimated deep SSI rates, when compared to CDC criteria. Wound photography should not replace clinical assessment in pragmatic trials but may be useful for screening purposes where surgical infection outcomes are paramount. Cite this article: Bone Joint J 2021;103-B(12):1802–1808.

A systematic review and meta‐analysis of randomised controlled trials of surgical treatments for ingrown toenails part II: healing time, post‐operative complications, pain, and participant satisfaction

“…These criteria were absence of exudate at gauze; formation of scab covering the wound; the wound must be kept uncovered; no signs of infection or inflammation at nail folds; no signs of erythema or hypergranulation tissue Reyzelman (2000) [26] Healing time was defined as the interval between the day the phenol matrixectomy was performed and the resolution of drainage and inflammatory changes surrounding the nail border. In every case, healing was identified by the principal investigator of the trial Tatlican (2009) [27] Complete healing was defined as the complete reepithelialization of the nail bed and the cessation of drainage Van der Ham (1990) [28] No definition provided Varma (1983) The average time to become pain-free was 3.6 days, with no statistical difference between the groups studied Andre (2018) [33] A and applied to nail surgery [54][55][56]. Despite the clear interest in post operative infection as an outcome, only one trial explored the use of oral antibiotics and found no evidence that they reduced the rate of post operative infection.…”

Phase 1 safety trial of a natural product cocktail with antibacterial activity in human volunteers

“…Assessments were undertaken by a trained healthcare professional within the research team rather than by an independent clinician or dermatologist. We have previous experience of judging adverse skin outcomes, including redness, spreading erythema, exudate and wound healing, in other patient populations, where inter-rater reliability was found to be substantial 33 .…”

Independent risk factor for surgical site infection after orthopedic surgery

“…[ 14 ] The reasons may be: that spinal and joint surgical incisions are cleaner, and most trauma surgeries are type III incisions, with an extensive range of surgical invasion, resulting in more soft tissue damage, thereby increasing the incidence of SSI. [ 15 ] Orthopedic “trauma” surgery patients become a population with nosocomial infections because of the relative length of orthopedic surgery, the widespread use of orthopedic implants, and the many invasive factors. [ 6 ] The higher infection rate of the surgical site in arthroplasty may be related to the more incredible surgical trauma, and postoperative local blood supply is affected to a certain extent and is not conducive to postoperative healing and other reasons.…”