Can dressings soaked with polyhexanide reduce bacterial loads in full-thickness skin grafting? A randomized controlled trial.
BACKGROUND
Polyhexamethylene biguanide (PHMB)-based antiseptic solutions can reduce bacterial loads in different clinical settings and are believed to lower risk of infections.


OBJECTIVE
We sought to assess the efficacy of a PHMB-based solution in lowering bacterial loads of full-thickness skin grafting wounds and the risk of surgical site infections (SSIs).


METHODS
In this double-blinded clinical trial, 40 patients planned for facial full-thickness skin grafting were randomized 1:1 to receive tie-over dressings soaked with either PHMB-based solution or sterile water. Quantitative and qualitative bacterial analysis was performed on all wounds before surgery, at the end of surgery, and 7 days postoperatively. In addition, all patients were screened for nasal colonization of Staphylococcus aureus.


RESULTS
Analysis of wounds showed no statistically significant difference in bacterial reductions between the groups. The SSI rates were significantly higher in the intervention group (8/20) than in the control group (2/20) (P = .028). Higher postoperative bacterial loads were a common finding in SSIs (P = .011). This was more frequent when S aureus was present postoperatively (P = .034), intraoperatively (P = .03), and in patients with intranasal S aureus colonization (P = .007).


CONCLUSIONS
Assessment of SSIs is largely subjective. In addition, this was a single-center study and the total number of participants was 40.


CONCLUSIONS
Soaking tie-over dressings with PHMB solution in full-thickness skin grafting had no effect on postoperative bacterial loads and increased the risk of SSI development. The presence of S aureus intranasally and in wounds preoperatively and postoperatively increased postoperative bacterial loads, which in turn resulted in significantly more SSIs.
Division of Dermatology and Venereology, Department of Clinical Sciences, Lund University, Skane University Hospital, Lund, Sweden. Electronic address: Karim.Saleh@med.lu.se.
Karim
K
Saleh
Division of Dermatology and Venereology, Department of Clinical Sciences, Lund University, Skane University Hospital, Lund, Sweden.
Andreas
A
Sonesson
Division of Dermatology and Venereology, Department of Clinical Sciences, Lund University, Skane University Hospital, Lund, Sweden.
Kerstin
K
Persson
Clinical Microbiology, Department of Translational Medicine, Lund University, Malmö, Sweden.
Kristian
K
Riesbeck
Division of Dermatology and Venereology, Department of Clinical Sciences, Lund University, Skane University Hospital, Lund, Sweden; LKCMedicine, Nanyang Technological University, Singapore.
Artur
A
Schmidtchen
D000368:Aged; D000369:Aged, 80 and over; D064592:Autografts / Q000382:microbiology; D058491:Bacterial Load / Q000187:drug effects*; D001458:Bandages; D001645:Biguanides / Q000494:pharmacology* / Q000627:therapeutic use; D004202:Disinfectants / Q000494:pharmacology* / Q000627:therapeutic use; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009666:Nose / Q000382:microbiology; D011446:Prospective Studies; D012867:Skin / Q000382:microbiology; D016038:Skin Transplantation / Q000009:adverse effects; D013211:Staphylococcus aureus / Q000302:isolation & purification; D013530:Surgical Wound Infection / Q000382:microbiology / Q000517:prevention & control*
D001645:Biguanides; D004202:Disinfectants; C031233:polihexanide
Staphylococcus aureus; bacteria; dermatologic surgery; pathogenesis; prevention; surgical site infections; wound infection