Reduction of leg wound infections following coronary artery bypass surgery.

OBJECTIVE: To reduce the rate of infection at the saphenous vein harvest site after coronary artery bypass surgery, to identify predictors of infection and to determine the best method for leg wound closure.

DESIGN: A randomized clinical trial was undertaken to determine the best technique for reducing the postoperative leg wound infection rate. Patients were allocated to one of four leg wound closure methods: staples, close immediately; staples, close after protamine administration; subcuticular sutures, close immediately; and subcuticular sutures, close after protamine. Risk factors evaluated were age, sex, diabetes, obesity, peripheral vascular disease, reoperation, time in surgery, wound length, wound depth, time that the wound was open, wound quality and harvest site.

SETTING: The Walter C Mackenzie Health Sciences Centre, University of Alberta, Edmonton, Alberta.

PATIENTS: All consenting patients undergoing elective coronary artery bypass surgery involving saphenous vein harvesting were considered for the study. Exclusion criteria were insertion of a drain, insertion of an intra-aortic balloon pump in the index limb and inability to complete follow-up at the authors' centre. Eighty patients were initially enrolled, with 77 completing the study.

INTERVENTIONS: Patients underwent standard saphenous vein harvesting followed by wound closure as indicated by the study group.

MAIN RESULTS: The major infection rate was reduced from 13% to 3% (P = 0.02). Each closure method was equally effective, and wound depth was the only factor related to infection.

CONCLUSIONS: Leg wound infections continue to be a major source of morbidity after coronary bypass surgery.