0.05% Chlorhexidine Gluconate Irrigation in Trauma/Emergency General Surgical Laparotomy Wounds Closure: A Pilot Study

• Published in: The Journal of surgical research Vol. 293; pp. 427 - 432
• Main Authors: Zebley, James A., Klein, Andrea, Wanersdorfer, Karen, Quintana, Megan T., Sarani, Babak, Estroff, Jordan M., Kartiko, Susan
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.01.2024
• Subjects: Acute care surgery; Chlorhexidine; Humans; Irrisept; Laparotomy - adverse effects; Pilot Projects; Retrospective Studies; Surgical site infection; Surgical Wound Infection - etiology; Surgical Wound Infection - prevention & control; Wound closure; Acute care surgery; Surgical site infection; Irrisept; Wound closure
• ISSN: 0022-4804; 1095-8673
• DOI: 10.1016/j.jss.2023.09.016

Patients who undergo exploratory laparotomy (EL) in an emergent setting are at higher risk for surgical site infections (SSIs) compared to the elective setting. Packaged Food and Drug Administration–approved 0.05% chlorhexidine gluconate (CHG) irrigation solution reduces SSI rates in nonemergency settings. We hypothesize that the use of 0.05% CHG irrigation solution prior to closure of emergent EL incisions will be associated with lower rates of superficial SSI and allows for increased rates of primary skin closure. A retrospective observational study of all emergent EL whose subcutaneous tissue were irrigated with 0.05% CHG solution to achieve primary wound closure from March 2021 to June 2022 were performed. Patients with active soft-tissue infection of the abdominal wall were excluded. Our primary outcome is rate of primary skin closure following laparotomy. Descriptive statistics, including t-test and chi-square test, were used to compare groups as appropriate. A P value <0.05 was statistically significant. Sixty-six patients with a median age of 51 y (18-92 y) underwent emergent EL. Primary wound closure is achieved in 98.5% of patients (65/66). Bedside removal of some staples and conversion to wet-to-dry packing changes was required in 27.3% of patients (18/66). We found that most of these were due to fat necrosis. We report no cases of fascial dehiscence. In patients undergoing EL, intraoperative irrigation of the subcutaneous tissue with 0.05% CHG solution is a viable option for primary skin closure. Further studies are needed to prospectively evaluate our findings.