The ‘transverse guard’ wound dressing technique to reduce faecal contamination after spinal surgery in neonates and infants
Wound care following lower spinal surgery in infants, especially open lumbosacral myelomeningocele (MMC) repair is challenging for a number of reasons: the babies' small size, uneven contour of the natal cleft, proximity of the wound to the perianal area, continuous soiling by loose/poorly-formed stool, and fragile skin. Faecal contamination of the wound can lead to infection, ascending meningitis and further morbidity. A single adhesive dressing does not reliably obliterate the space in the natal cleft and, therefore, does not prevent faecal material tracking rostrally underneath the dressing. This increases the risk of contamination and necessitates frequent wound dressing changes. The authors describe the use of the ‘transverse guard’, a simple technique routinely used in their unit that help overcome these problems. They also report on the wound infection rates of neonates undergoing open MMC repair who had the new dressings versus those who had conventional dressings.
Open myelomeningocele (MMC) in neonates constitutes a neurosurgical emergency requiring early closure of the defect to prevent the sequelae of ascending infection, namely meningitis and further damage to the exposed neural tissue (Attenello et al, 2016; Beier et al, 2019; Mazzola et al, 2019). Children with a history of bacterial meningitis are at greater risk of reduced intellectual and cognitive function later in life (Grimwood et al, 2000). Following MMC repair and other lower spinal surgeries, neonates/infants require meticulous postoperative wound care to prevent wound dehiscence and infection, which requires prolonged hospital stay and further treatment including surgery.
Although wound dressings have been used since antiquity, there continues to be uncertainty about their efficacy in preventing surgical site infection in wounds healing by primary intention (Broughton et al, 2006; Dumville et al, 2016; Jones et al, 2017). In contemporary practice, surgical wound care can be divided broadly into exposed wound and application of contact dressings. The main dressing material types include foam, absorbent, film, silver-containing, hydrocolloid and antimicrobial dressings. Previous studies have been limited by the small sample size and risk of bias in terms of allocation concealment and outcome assessment, and have focused on wounds of clean surgery and potentially contaminated surgery (Dumville et al, 2016). Therefore, there is ongoing debate regarding which particular dressing material is more effective (Dumville et al, 2016).
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