title: Surgical factors in the prevention of infection following major lower limb amputation.
abstract: OBJECTIVE
  Infection following major lower limb amputation is common but surgical influences on the rates of infection are not known. We aim to assess the influence of peri-operative surgical factors on outcome.
  
  
  METHODS
  Review of a prospective database included all patients undergoing a major lower limb amputation from March 2008 to July 2010. Infection was classified using Centre for Disease Control criteria and multivariate analysis performed to identify significant risk factors.
  
  
  RESULTS
  127 patients, median age 78 yrs (31-98) were included. 34.6% of patients developed a wound infection following surgery; 47.7% of which were classed as superficial incisional surgical site infections, with 52.3% being deep incisional surgical site infections. There was a higher infection rate in below knee than above knee amputations (p < 0.001). There was no relationship between the grade of the operating surgeon (p = 0.829), peri-operative antibiotics (p = 0.933), length of operation (p = 0.651), use of nerve catheter (0.267) and the post-operative presence of infection. There was a higher rate of infection with the use of suction drains (p < 0.05). The use of skin clips rather than sutures was associated with an increased rate of infection (p < 0.05). There was an increased need for revision surgery with the use of skin clips, although this was not significant (p = 0.07).
  
  
  CONCLUSIONS
  Skin clips and surgical drains adversely influence the risk of infection in major limb amputation and their use should be avoided.
authors.affiliation: Department of Vascular Surgery, Musgrove Park Hospital, Taunton, United Kingdom. jamescoulston@yahoo.co.uk
authors.forename: J E
authors.initials: JE
authors.lastname: Coulston
authors.forename: V
authors.initials: V
authors.lastname: Tuff
authors.forename: C P
authors.initials: CP
authors.lastname: Twine
authors.forename: J F
authors.initials: JF
authors.lastname: Chester
authors.forename: P S
authors.initials: PS
authors.lastname: Eyers
authors.forename: A H R
authors.initials: AH
authors.lastname: Stewart
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical / Q000009:adverse effects*; D016208:Databases, Factual; D006801:Humans; D035002:Lower Extremity / Q000601:surgery*; D008875:Middle Aged; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000209:etiology / Q000517:prevention & control*