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J U LY 2 0 1 5 | O U T P A T I E N TS U R G E R Y. N E T
including mastectomies, open appendectomies and even minor exci-
sion wounds.
Here's how to do it:
• Begin irrigation after closure of the fascia.
• Make sure the head of the operating table is elevated and that you
have a basin at the lower end of the wound.
• Use voluminous amounts of saline (typically 2 to 5 liters) and vig-
orously finger massage the wound margins.
• To ensure that all devitalized and loose fatty tissue is removed,
continue irrigating until no loose fat tissue floods over the inferior
aspect of the incision.
The technique adds little time to the procedure, it's inexpensive, and
it works. My partner and I have used vigorous irrigation of the subcu-
taneous tissue to remove devitalized fat in 600 open vertical banded
gastroplasties and haven't had a single major wound infection. I have
no doubt that the time we've invested has decreased the cost of care
by preventing potentially costly complications. OSM
Dr. Biesecker (vivngar@aol.com) specializes in
general surgery at High Point (N.C.) Regional Hospital.
