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Proceedings of the International Consensus Meeting on Periprosthetic Joint Infection

Javad Parvizi MD, FRCS
Thorsten Gehrke MD


Title:
Wound Management

Liaisons:
Elie Ghanem MD

Leaders:
Volkmar Heppert MD (International), Mark Spangehl MD, FRCSC (US)

Delegates:
John Abraham MD, Khalid Azzam MD, Lowry Barnes MD, Federico Jose Burgo MD, Walid Ebeid MD, Nitin Goyal MD, Ernesto Guerra MD, Kirby Hitt MD, Sofiene Kallel MD, Gregg Klein MD, Yona Kosashvili MD, Brett Levine MD, Laura Matsen MD, Michael J Morris MD, James J Purtill MD, Chitranjan Ranawat MD, FRCS, FRCSC, Peter F Sharkey MD, Rafael Sierra MD, Anna Stefansdottir MD, PhD

Vol 1, Num S1, September 2014

 

   

Question 1A: What is the optimal dressing for a wound after total joint arthroplasty (TJA)?

Consensus: We recommend the use of occlusive dressings with alginated hydrofiber, when available.

Delegate Vote: Agree: 63%, Disagree: 25%, Abstain: 12% (Weak Consensus)


Question 1B: Does the use of silver-impregnated dressings reduce SSI /PJI?

Consensus: Silver-impregnated dressings have not been conclusively shown to reduce SSI/PJI.

Delegate Vote: Agree: 87%, Disagree: 5%, Abstain: 7% (Strong Consensus)


Question 2: What is considered to be persistent drainage from a wound after TJA?

Consensus: Persistent wound drainage after TJA is defined as continued drainage from the operative incision site for greater than 72 hours.

Delegate Vote: Agree: 80%, Disagree: 15%, Abstain: 5% (Strong Consensus)


Question 3A: What are non-surgical strategies to address a draining wound after TJA?

Consensus: Persistent wound drainage for greater than 72 hours after TJA should be managed by wound care.

Delegate Vote: Agree: 65%, Disagree: 26%, Abstain: 9% (Weak Consensus)


Question 3B: What are surgical strategies to address a draining wound after TJA?

Consensus: Surgical management consisting of opening the fascia, performing a thorough irrigation and debridement (I&D) with exchange of modular components should be considered if wound drainage has persisted for 5 to 7 days after the index procedure.

Delegate Vote: Agree: 77%, Disagree: 16%, Abstain: 7% (Strong Consensus)


Question 3C: Should oral or intravenous antibiotics be administered to patients with persistent wound drainage?

Consensus: We recommend against administration of oral or intravenous antibiotics to patients with persistent wound drainage.

Delegate Vote: Agree: 80%, Disagree: 17%, Abstain: 3% (Strong Consensus)


Question 4: What are the indications for reoperation for a persistently draining wound after TJA?

Consensus: A wound that has been persistently draining for greater than 5 to 7 days from the time of diagnosis should be reoperated on without delay.

Delegate Vote: Agree: 77%, Disagree: 19%, Abstain: 4% (Strong Consensus)


Question 5: How can we optimize patient status prior to reoperation to minimize SSI?

Consensus: We recommend that patients should be optimized prior to undergoing reoperation. Correction of malnutrition, anticoagulation, anemia, and diabetes should be reasonably pursued.

Delegate Vote: Agree: 95%, Disagree: 3%, Abstain: 2% (Strong Consensus)


Question 6: Should intraoperative cultures be taken when performing I&D for a persistently draining wound after TJA?

Consensus: Yes. Intraoperative cultures (minimum of 3) should be taken when performing I&D reoperation for a persistently draining wound.

Delegate Vote: Agree: 98%, Disagree: 1%, Abstain: 1% (Strong Consensus)


Question 7: Should perioperative antibiotics be withheld prior to skin incision for I&D of TJA?

Consensus: No. Perioperative antibiotics given within one hour prior to I&D reoperation should not be withheld prior to skin incision.

Delegate Vote: Agree: 82%, Disagree: 14%, Abstain: 4% (Strong Consensus)


Question 8: What is the optimal method for wound closure after TJA to minimize the risk of SSI and PJI?

Consensus: Despite the lack of evidence supporting the superiority of one technique of skin closure over others (staples, suture, adhesive, or tapes), we recommend the use of monofilament suture for wound closure in patients who undergo reoperation for wound-related problems during the early postoperative period after index arthroplasty.

Delegate Vote: Agree: 75%, Disagree: 15%, Abstain: 10% (Strong Consensus)