Commentary

Wound infections are an important cause of morbidity after abdominal surgery. Perioperative antibiotic prophylaxis reduces the risk for infection in clean contaminated surgery; other prophylactic strategies are less well defined. The study by Sookhai and colleagues suggests that use of a plastic wound edge protector can further reduce risk for infection. The data are both statistically significant and biologically plausible: the greatest benefit occurs in contaminated wounds, where the bacterial load in previously uninfected subcutaneous tissues is the greatest.

Should we change surgical behaviour? I believe not, although the findings merit further evaluation. Wound infection rates in this series are high. The authors' baseline rate of 13% in clean contaminated wounds is substantially above the 3.3% rate reported by the US National Nosocomial Infection Surveillance System study.¹ Furthermore, previous randomised trials of wound protectors have failed to show a reduction in wound infection rates.^{2, 3} Finally, the economic benefit postulated by the authors is almost certainly inflated.

An abbreviated report such as this research letter is a tease that leaves the reader intrigued but unconvinced. One wants further details on inclusion and exclusion criteria, the definitions used, the methods of surveillance, the analytic plan, and the outcome data describing the nature and timing of the wound infections that developed. On the basis of this elliptical report, the practice appears reasonable when the probability of contamination is high, for example, when operating in penetrating abdominal trauma or on an obstructed gastrointestinal tract. Wider application should await the result of a more rigorously designed multicentre study.