Postoperative cutaneous wound infections

Postoperative infectious complications are a frequent cause of morbidity and mortality in the surgical patient. These septic events usually involve the urinary or respiratory tracts or occur in the operative wound. The overall incidence of postoperative wound infection was 7.5% in a much-quoted national study reported nearly two decades ago.¹ The incidence varied from surgeon to surgeon, from hospital to hospital, and from one surgical procedure to another. The lowest infection rate (< 2%) followed clean operations, such as elective orthopedic procedures or herniorrhaphy, in which the possible sources of wound contamination were solely airbone or exogenous. Clean-contaminated operations that resulted in additional exposure of the operative site to the endogenous microflora had higher rates of infection (10 to 20%).Some surgeons have been relatively nonchalant about uncomplicated wound sepsis, thinking that it rarely influenced the patient's physical or psychological well-being or markedly altered the duration or cost of hospitalization; however, Green and Wenzel² reported that the average hospital stay doubled and the costs of hospitalization were thus increased when postoperative wound infection developed after any of six commonly performed operations.The economic, physical, and psychological impact of postoperative wound sepsis mandates the use of preventive methods,³ of which the most critical are proper operative technique and sound judgment—e.g., in the choice of operation—on the part of a responsible surgeon and his team. In addition, well controlled prospective, blinded clinical studies have defined the circumstances in which antibiotic prophylaxis is of benefit, as well as the situations in which the risks of prophylaxis outweigh the expected benefit,⁴ and have led to authoritative recommendations concerning the indications for antibiotic prophylaxis in the surgical patient.^5,6For the dermatologist who may be called upon to assist in repair of postoperative cutaneous wound infection, we review the factors that can lead to this complication.