Surgical factors in the prevention of infection following major lower limb amputation

Abstract

Objectives: Infection following major lower limb amputation is common but surgical influences on the rates of infection are not known. We aim to assess the influence of peri-operative surgical factors on outcome.

Design and methods: Review of a prospective database included all patients undergoing a major lower limb amputation from March 2008 to July 2010. Infection was classified using Centre for Disease Control criteria and multivariate analysis performed to identify significant risk factors.

Results: 127 patients, median age 78 yrs (31-98) were included. 34.6% of patients developed a wound infection following surgery; 47.7% of which were classed as superficial incisional surgical site infections, with 52.3% being deep incisional surgical site infections. There was a higher infection rate in below knee than above knee amputations (p < 0.001). There was no relationship between the grade of the operating surgeon (p = 0.829), peri-operative antibiotics (p = 0.933), length of operation (p = 0.651), use of nerve catheter (0.267) and the post-operative presence of infection. There was a higher rate of infection with the use of suction drains (p < 0.05). The use of skin clips rather than sutures was associated with an increased rate of infection (p < 0.05). There was an increased need for revision surgery with the use of skin clips, although this was not significant (p = 0.07).

Conclusions: Skin clips and surgical drains adversely influence the risk of infection in major limb amputation and their use should be avoided.