Improvement of perineal wound healing by local administration of gentamicin-impregnated collagen fleeces after abdominoperineal excision of rectal cancer

• Published in: The American journal of surgery 2001-11, Vol.182 (5), p.502-509
• Main Authors: Gruessner, Uwe, Clemens, Manfred, Pahlplatz, Paul V, Sperling, Peter, Witte, Jürgen, Rosen, Harald R
• Format: Article
• Language: English
• Subjects: Abdominoperineal excision; Absorbable Implants; Administration, Topical; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents - administration & dosage; Anti-Bacterial Agents - adverse effects; Antibiotics; Bacteria - isolation & purification; Biological and medical sciences; Biomaterials; Biomedical materials; Blood & organ donations; Cancer; Carrier density; Collagen; Collagen fleece; Colon; Colorectal cancer; Complications; Disease prevention; Drainage; Drug Carriers; Effectiveness; Gentamicin; Gentamicins - administration & dosage; Gentamicins - adverse effects; Gentamycin; Humans; Infections; Medical sciences; Middle Aged; Pathogens; Patients; Perineum; Perineum - microbiology; Perineum - surgery; Postoperative; Postoperative Care; Postoperative infection; Prospective Studies; Rectal cancer; Rectal Neoplasms - surgery; Rectum; Sacral cavity; Sacrococcygeal Region - microbiology; Sacrum; Single-Blind Method; Stomach, duodenum, intestine, rectum, anus; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Surgical drains; Surgical Wound Infection - prevention & control; Wound drainage; Wound Healing; Wound infection
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/S0002-9610(01)00762-0

Background: Despite significant advancements in rectal surgery, poor perineal wound healing after abdominoperineal resection (APR) of the anorectum continues to be a potential complication of the procedure. The aim of this prospective randomized multicenter study was to investigate the efficacy of a new mode of local antibiotic administration. Patients and methods: Ninety-seven patients who had to undergo APR for low rectal carcinoma either received sacral drainage plus primary wound closure (control group, n = 48) or the same treatment and supplementary application of three resorbable gentamicin-impregnated collagen fleeces (Septocoll; Merck Biomaterial GmbH, Darmstadt, Germany; Genta group, 49). The following target criteria were investigated: bacteriologic efficacy with respect to the eradication of Enterobacteriaceae, Staphylococcus, and Pseudomonas organisms, and clinical efficacy with respect to perineal wound healing. Results: The Genta group showed a marked reduction in the investigated pathogens from the secretion obtained by sacral drainage on days 1 and 3, as well as high gentamicin concentrations (day 1, median 126.2 μg/mL; day 3, median 97.6 μg/mL). In total, bacteriologic efficacy amounted to 83.7% in the Genta group (41 of 49 patients) versus 60.4% (29 of 48 patients) in controls ( P = 0.013). In concurrence with these bacteriologic results, the postoperative infection rate was significantly higher in controls: 10 patients (20.83%) in the control group versus 3 (6.1%) in the Genta group developed perineal or sacral infection ( P