This study by Hinkson et al. (European Journal of Obstetrics Gynecology and Reproductive Biology, 2016) sought to determine if plastic-sheath wound retractors, which show reduced infection rates in abdominal surgery would likewise decrease rates of infection following C-section.
Randomized Controlled Trial (RCT)
Use of plastic-sheath wound retractors were compared to metal self-retaining retractors. Primary outcome, surgical site infection, was defined using CDC definitions. All patients received pre-operative antibiotics and spinal anesthetic. Operative field was cleansed suing a ethanol based solution. 98 patients underwent surgery with the Alexis, and 100 with the Collins. The use of the plastic-sheath retractor reduced infection rates 1% vs. 8% infection rate, respectively (relative risk 7.84, 95% CI 2.45-70.71; p=0.035). Secondary outcomes demonstrated easier application with the plastic-sheath as well as decreased blood loss (<500 ml, p=0.001). In the metal retractor group, there was more surgical maneuvering required (e.g. bowel repositioning, p=0.001), more scar pain (p=0.001) and higher pain medication requirements (p=0.001). There was not difference in terms of indications for C-section. The authors suggest the use of a plastic-sheath wound retractor in low-risk women undergoing their first, planned C-section significantly decreases rates of surgical site infection. (Study funded by Applied Medical Company but had no role in the study).
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