Wound care after posterior spinal surgery. Does early bathing affect the rate of wound complications?

Abstract

Study design: The study was a prospective clinical trial with historic control.

Objectives: To determine if early bathing after posterior spinal surgery resulted in increased wound problems.

Summary of background data: Little is known about the time needed for wound healing before patients may get the wound wet. Traditional teaching usually calls for the wound to be kept clean and dry for 10-14 days or until shortly after the sutures are removed. Studies have shown wound closure with skin staples to be resistant to external contamination.

Methods: One hundred consecutive patients undergoing posterior spinal surgery with skin closure using steel skin staples were prospectively allowed to shower and wet the surgical wound 2-5 days after surgery. These results were compared with a historic control of 100 consecutive patients done in the previous year by the same surgeon with a similar patient profile, albeit with fewer patients who underwent revision surgery and instrumentation in the control group. Follow-up evaluation was done by an independent reviewer. Certain high risk patients were excluded from the trial and control groups.

Results: Ninety-five patients in the historic control group were available for follow-up evaluation, and 97 of the experimental (early bathing group) were available. There was one deep infection in the control group and none in the experimental group. There were three superficial wound problems in the control group, and two in the early bathing group. All superficial wound troubles healed without sequelae. Operating time, complexity, and revision rates were slightly higher in the experimental group.

Conclusions: Prohibition of showering of patients after uncomplicated posterior spinal surgery and wound closure with skin staples may be unnecessary beyond the first few days.