Early detection of deep wound infection in bladder exstrophy and hypospadias using a novel intervention.

OBJECTIVE:: To introduce a practical technique for the early detection and prompt management of a probable bladder dehiscence (BD) and glanular dehiscence (GD) in patients with bladder exstrophy epispadias complex (BEEC) and hypospadias.

METHOD:: In this prospective study, paediatric patients with BEEC (group 1) and with proximal hypospadias (group 2) underwent body temperature measurement using a non-contact infrared radiant digital temperature measurement device in four body regions, including the surgical wound, forehead, right hand, and right foot at eight hour intervals, postoperatively. This technique was performed to detect wound temperature rises before whole body temperature rise or visible local wound skin redness, cellulitis or any sign of inflammation or wound dehiscence (WD).

RESULTS:: A total of 24 paediatric patients were recruited. Temperature rise in the surgical wound area was discovered in two patients with BEEC. The temperature reached 39.2°C in the first case (12 days postoperative) and 39.4°C in the second case (16 days postoperative). Urinalysis, urine culture, and clean surgical wound sampling was performed and the presence of Gram-positive microorganisms was detected. Both patients were managed with intravenous imipenem and vancomycin. After changing the antibiotic regimen, wound temperature was gradually decreased to 37.2°C in the first patient by day 16, and to 36.9°C in the second patient by day 21, without rise in body temperature. Other patients in group 1 and all patients in group 2 had normal wound temperature fluctuations within the follow-up period.

CONCLUSION:: Postoperative periodical temperature measurement by a non-contact infrared radiant digital temperature measurement device is a safe and feasible technique that has the ability to detect deep wound infection, and may prevent the occurrence of WD before any visible sign of inflammation.