A simple vacuum dressing reduces the wound infection rate of single-incision pediatric endosurgical appendectomy

Abstract

Background and objectives: After introducing single-incision pediatric endosurgical (SIPES) appendectomy at our institution, we noticed an increased number of post-operative umbilical infections. This study evaluates the impact of a simple, low-cost wound vacuum dressing on the wound infection rate.

Methods: Umbilical wounds after single-incision laparoscopic appendectomy were covered with standard dressing (approximating strips), or the new umbilical vacuum dressing. A wound infection was defined as an infected umbilicus requiring antibiotics, or incision and drainage. The wound infection rate was compared between both groups. Statistical analysis was performed using Fischer's exact test. Continuous variables were compared using the Student t test.

Results: Included in this study were 183 children, 97 of whom were treated with the vacuum dressing. The study populations were no different in terms of age, weight, operative time, blood loss, length of stay, or proportion of acute versus perforated appendicitis. A total of 7 (3.8%) wound infections occurred, 1 in the vacuum dressing group (1%), versus 6 in the conventional dressing group (7%, P=0.038).

Conclusions: This simple, low-cost umbilical vacuum dressing decreased the wound infection rate after SIPES appendectomy, possibly by absorbing secretions from the base of the wound. It may be equally effective for other indications.

Figures

Figure 1.

Illustration of the vacuum dressing. After wound closure, a 2” x 2” gauze is folded, placed onto the umbilicus (a), and covered with a bioocclusive dressing (b). A 22-g needle on a 10- mL syringe is passed percutaneously from outside the dressing into the gauze (c), and the air around the gauze is evacuated (d).

Figure 2.

After 2 days, the gauze is saturated with secretions aspirated from the base of the wound by the vacuum created under the dressing.

Figure 3.

Wound infection in the vacuum dressing group. It resolved with a course of oral clindamycin for 7 days.