Objective : The aim of this trial was to verify whether use of subcutaneous suction drainage with subcuticular sutures for wound closure might decrease the incidence of incisional surgical site infection (SSI) after general abdominal surgery. Summary Background Data : The ideal method for wound closure following general abdominal surgery has not been established yet. Methods : Patients were randomly assigned to receive either subcutaneous drainage with subcuticular sutures (drainage group) or subcutaneous sutures with skin stapling (control group). The primary end point was the incidence of incisional SSI within 30 days after surgery. This trial is registered with UMIN-CTR, number UMIN000003073. Results : A total of 160 patients were randomly assigned to the drainage group (n＝81) or the control group (n＝79). Incisional SSI was observed in 12 patients (14.8%) in the drainage group, and 15 patients (19.2%) in the control group, with no significant difference between the two groups (P＝0.459). Subgroup analyses showed that the drainage method significantly reduced the incidence of SSIs in patients with diabetes mellitus (P＝0.048) and/or a subcutaneous fat pad thickness of ≥2.3cm (P＝0.043). Conclusion : Application of the subcutaneous drainage with subcuticular suture method for wound closure was not associated with any significant decrease in the incidence of incisional SSIs as compared to that of the conventional method. However, the drainage method might be beneficial for reducing the risk of SSIs in patients with diabetes mellitus and/or a subcutaneous fat pad thickness of ≥2.3cm.
Background : The estimated incidence of infected cardiac implantable electric devices (CIED) has recently increased to 1%-2%. Prompt removal of infected devices improves survival rates. We describe our initial experience of lead extraction from infected devices using an excimer laser that was approved for this application in 2010. Methods and results : We retrospectively analyzed the characteristics, type of devices and leads, as well as indications and complications in 13 patients with CIED infection between 2011 and 2014 at our hospital. The clinical presentation comprised isolated pocket infection (n＝12), lead endocarditis (n＝3) and methicillin-resistant Staphylococcus aureus-positive blood cultures. The patients had been implanted with a total of 29 leads (atrial, n＝13 ; ventricular, n＝16) for a median duration of 10.2±5.2 years. The procedure was successful in all patients, but two patients who developed recurrent infection required repeated removal of devices and an implant device from epicardial cardiac muscle. Acute cardiac tamponade occurred in one patient after ventricular lead extraction due to perforation of the right ventricle. This patient required an emergency thoracotomy, but was discharged one month after the procedure. Conclusion : Infected CIED leads can be quickly extracted using an excimer laser.