The ‘transverse guard’ wound dressing technique to reduce faecal contamination after spinal surgery in neonates and infants

Abstract

Wound care following lower spinal surgery in infants, especially open lumbosacral myelomeningocele (MMC) repair is challenging for a number of reasons: the babies' small size, uneven contour of the natal cleft, proximity of the wound to the perianal area, continuous soiling by loose/poorly-formed stool, and fragile skin. Faecal contamination of the wound can lead to infection, ascending meningitis and further morbidity. A single adhesive dressing does not reliably obliterate the space in the natal cleft and, therefore, does not prevent faecal material tracking rostrally underneath the dressing. This increases the risk of contamination and necessitates frequent wound dressing changes. The authors describe the use of the ‘transverse guard’, a simple technique routinely used in their unit that help overcome these problems. They also report on the wound infection rates of neonates undergoing open MMC repair who had the new dressings versus those who had conventional dressings.