title: Antimicrobial gauze as a dressing reduces pin site infection: a randomized controlled trial.
abstract: BACKGROUND
  Pin site infection is a common problem in external fixation. Plain gauze wetted with normal saline is commonly used for a pin site dressing owing to the simplicity and low cost. Evidence to support adding an antimicrobial agent in the dressing material is lacking.
  
  
  OBJECTIVE
  We compared the rate of pin tract infection using plain gauze and gauze impregnated with polyhexamethylene biguanide in patients undergoing limb lengthening procedures.
  
  
  METHODS
  We included 38 patients (40 limbs) undergoing limb lengthening or deformity correction using an external fixator between July 2009 and June 2010. There were 23 male patients and 15 female patients, with a mean age of 26.3 years (range, 5-68 years). The patients were randomized into two groups: a polyhexamethylene biguanide group (22 limbs) and a control group (18 limbs). The metal-skin interfaces were assessed by a researcher blinded to the type of gauze at 2, 4, 8, and 12 weeks after surgery for the pin site infection based on a predetermined grading system. There were a total of 483 metal-skin interfaces, with 1932 total observations. Infection rates were compared using the chi square test and relative risk with 95% confidence interval.
  
  
  RESULTS
  The infection rate was lower (χ(2) [1, n = 1932] = 23.00) and the risk for infection was lower (relative risk, 0.228; 95% confidence interval, 0.118, 0.443) for the polyhexamethylene biguanide group (n = 1068; 1.0%) than for the control group (n = 864; 4.5%).
  
  
  CONCLUSIONS
  Use of polyhexamethylene biguanide-impregnated gauze can reduce the risk of pin tract infection in external fixation.
  
  
  METHODS
  Level I, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
authors.affiliation: Department of Orthopaedic Surgery, University Malaya Medical Centre, 50603 Kuala Lumpur, Malaysia. kenetto@hotmail.com
authors.forename: C K
authors.initials: CK
authors.lastname: Lee
authors.forename: Y P
authors.initials: YP
authors.lastname: Chua
authors.forename: A
authors.initials: A
authors.lastname: Saw
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001458:Bandages; D001645:Biguanides / Q000008:administration & dosage*; D001858:Bone Nails / Q000009:adverse effects*; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D004202:Disinfectants / Q000008:administration & dosage*; D004311:Double-Blind Method; D005260:Female; D005592:Fracture Fixation / Q000009:adverse effects* / Q000295:instrumentation*; D006801:Humans; D008296:Malaysia; D008297:Male; D008670:Metals; D008875:Middle Aged; D011474:Prosthesis Design; D016459:Prosthesis-Related Infections / Q000382:microbiology / Q000517:prevention & control*; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D001645:Biguanides; D004202:Disinfectants; D008670:Metals; C031233:polihexanide