step if far cheaper than the $75,000 or so it would cost to treat an
infection.
Irrigation is also quick. Generally speaking, all it takes is 5 minutes
at the end of surgery to do a proper wound irrigation. And sometimes
it takes as little as 2 minutes. One exception being when you're doing
an abdominal surgery on a morbidly obese patient. Here, you could be
dealing with a subcutaneous layer that's anywhere from 5 to 10 inches
thick. After closing up the fascia, and gently massaging the subcuta-
neous layer with your fingers while you irrigate, you need to work
until all the fat globules come out of the wound. And you wouldn't
believe how much devitalized fat comes out in these cases.
As intensive as this can be, it's well worthwhile to irrigate. Of the
600 open vertical banded gastroplasties my partner and I performed
using vigorous irrigation of the subcutaneous tissue to remove fat
globules, we haven't had a single major wound infection. You can't
argue with those results.
OSM
7 8 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • O C T O B E R 2 0 1 8
Dr. Biesecker (vivngar@aol.com) is a retired surgeon who specialized in general
surgery at High Point (N.C.) Regional Hospital.