title: A wound protector shields incision sites from bacterial invasion.
abstract: BACKGROUND
  Superficial surgical site infection (SSI) can be caused by bacterial invasion during surgery. We investigated whether bacteria are found at the wound margin during surgery and whether a wound protector (WP; Alexis® Wound Retractor; Applied Medical, Rancho Santa Margarita, CA) contributes to preventing invasion of the incision margin.
  
  
  METHODS
  We studied 272 patients who underwent gastrointestinal surgery (115 gastric, 157 colorectal, including emergency operations) between October 2005 and July 2007. The WP was used in all operations. After the intra-abdominal procedures were complete, bacterial swabs were taken from the abdominal cavity side of the WP and from the incision margin and used to prepare smears and cultures. After the swabbing, peritoneal lavage was performed using 3,000-5,000 mL of physiologic saline, and, after suture of the fascia, 500-1,000 mL of physiologic saline was used to irrigate the subcutaneous tissue.
  
  
  RESULTS
  Nine gastric surgery patients and 15 colorectal surgery patients had positive cultures from the abdominal cavity. No patients had positive cultures from the incision margin. Of the 24 patients with positive cultures, three suffered SSIs, all of whom had undergone colorectal surgery. Of the patients who had negative cultures, SSI occurred in only one patient, who had undergone colorectal surgery.
  
  
  CONCLUSIONS
  These results suggest that the WP protects an incision site from bacterial invasion.
authors.affiliation: Department of Surgery, Minami Wakayama Medical Center, Wakayama, Japan. horiuti.tetuya@lilac.plala.or.jp
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Horiuchi
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Tanishima
authors.forename: Kouji
authors.initials: K
authors.lastname: Tamagawa
authors.forename: Satoru
authors.initials: S
authors.lastname: Sakaguchi
authors.forename: Yoshiharu
authors.initials: Y
authors.lastname: Shono
authors.forename: Hideaki
authors.initials: H
authors.lastname: Tsubakihara
authors.forename: Katsuyoshi
authors.initials: K
authors.lastname: Tabuse
authors.forename: Yukiyasu
authors.initials: Y
authors.lastname: Kinoshita
mesh_terms: D001424:Bacterial Infections / Q000517:prevention & control*; D004864:Equipment and Supplies; D006801:Humans; D015995:Prevalence; D013530:Surgical Wound Infection / Q000517:prevention & control*; D016896:Treatment Outcome; D014945:Wound Healing