Gentamicin-collagen Sponge Research Articles

A meta-analysis examined the effect of topical nursing application of antimicrobial as a prophylaxis for the stoppage of surgical wound infection in colorectal surgery.

To assess the impact of topical antimicrobial (TA) as a prophylaxis for the stoppage of surgical wound infection (SWI) in colorectal surgery (CS), we lead a meta-analysis. 9160 participants with CS were enrolled in the chosen studies; 4719 of them used TA, while 4441 served as controls. To assess the effectiveness of TA application in lowering SWIs following CS, odds ratios (OR) with 95% confidence intervals (CIs) were computed with a dichotomous technique with a fixed- or random-effect model. Significantly lower SWIs post CS for TA as whole (OR, 0.50; 95% CI, 0.38-0.64; P< .001), gentamicin collagen sponge and beads (OR, 0.52; 95% CI, 0.32-0.86; P= .01), triclosan impregnated fascial suture (OR, 0.57; 95% CI, 0.38-0.84; P= .005), antibiotic powder, ointment, lavage, or injection for the abdominal wound (OR, 0.35; 95% CI, 0.21-0.59; P< .001), and ionised silver dressing on the closed abdominal wound (OR, 0.45; 95% CI, 0.27-0.77; P= .003) compared to control. Significantly lower SWIs post CS for TA as a whole, gentamicin collagen sponge and beads, triclosan impregnated fascial sutures, antibiotic powder, ointment, lavage, or injection for the abdominal wound, and ionised silver dressing on the closed abdominal wound compared with control. The low sample size of 8 out of the 39 included studies in this meta-analysis calls for precaution when analysing the outcomes.

Effect of Gentamicin Collagen Sponge on Wound Healing: In Vivo Study and Assessment of Its Effectiveness against Nosocomial Bacteria

Background: Gentamicin collagen sponge (Genta-Coll) reportedly has a hemostatic effect and promotes wound healing. However, it may also interfere with wound healing by causing foreign body reactions. We planned to analyze the effect of Genta-Coll on wound healing by inducing muscle defects in the rectus abdominis muscle of rats. We also assessed the effectiveness of Genta-Coll in preventing surgical site infections (SSIs) using the zone of inhibition tests to determine the sensitivity of pathogenic bacteria.Methods: We created an 8×8-mm muscle defect in both recti abdominis of 15 white Sprague-Dawley rats and distributed them into the control group (no care) and group A (Genta-Coll). Three biopsies were performed for histologic analysis (on days 3, 7, and 27). In the second study, we placed Genta-Coll on Mueller–Hinton agar plates seeded with pathogenic microorganisms commonly responsible for SSIs. The zone of inhibition was measured after 24 and 48 hours of incubation.Results: Group A showed a slightly higher score for foreign body giant cells and inflammation, with no significant difference. Granulation and neovascularization were constantly high in group A, and muscle regeneration was also high in group A. Extracellular matrix formation advanced at a similar pace in both groups. Genta-Coll created a zone of inhibition against all microorganisms except for Candida albicans. The effect lasted without change between 24 and 48 hours.Conclusion: While foreign body reactions and inflammation increased in group A, wound healing was unaffected. Genta-Coll can promote faster wound healing with an anti-bactericidal effect against SSI pathogens.

Use of gentamicin-collagen sponge (Collatamp® G) in minimally invasive colorectal cancer surgery: A propensity score-matched study.

Minimally invasive surgery is commonly used to treat patients with colorectal cancer, although it can cause surgical site infections (SSIs) that can affect the oncologic outcome. Use of a gentamicin-collagen sponge may help reduce the occurrence of SSIs. We aimed to determine the effectiveness of a gentamicin-collagen sponge in reducing SSIs in minimally invasive surgery for colorectal cancer. We retrospectively reviewed the records of 310 patients who were diagnosed with colorectal cancer at our hospital and underwent minimally invasive surgery between December 1, 2018, and February 28, 2021. Propensity score matching was conducted with a 1:1 ratio using logistic regression. The primary outcome was the incidence of SSIs in the mini-laparotomy wound. The secondary endpoints were factors affecting the incidence of SSIs. After propensity score matching, 130 patients were assigned to each group. There were no differences in clinical characteristics between the two groups. SSIs occurred in 2 (1.5%) and 3 (2.3%) patients in the gentamicin-collagen sponge and control groups, respectively (p<0.999). The following factors showed a statistically significant association with SSIs: body mass index >25 kg/m2 (odds ratio, 39.0; 95% confidence interval, 1.90-802.21; p = 0.018), liver disease (odds ratio, 254.8; 95% confidence interval, 10.43-6222.61; p = 0.001), and right hemicolectomy (odds ratio, 36.22; 95% confidence interval, 2.37-554.63; p = 0.010). Applying a gentamicin-collagen sponge to the mini-laparotomy wound did not reduce the frequency of SSIs. Further studies should be conducted on whether the selective use of gentamicin-collagen sponges may help reduce SSIs in high-risk patients.

Gentamicin-collagen sponge and prevention of cardiac implantable electronic device infections: bargain basement or penthouse suite?

Gentamicin-collagen sponge and prevention of cardiac implantable electronic device infections: bargain basement or penthouse suite?

Long-term results of randomized studies on the use of a gentamicin-collagen sponge in rectal cancer – depending on the length of time between the completion of radiotherapy and the surgery

Introduction. Two randomized studies on the use of a gentamicin-collagen sponge (GRM01/1997 and GRM02/2007) in rectal cancer surgery showed a statistically significant decrease in the rate of distant metastases in the experimental group and a similar rate of local recurrences. The objective of the presented study was a retrospective evaluation of the effect of the GRM use on the observed rate of generalized recurrences, disease-free survival (DFS), overall survival (OS) and cancer-specific survival (CSS) – depending on the length of the interval between radiotherapy and surgery. Materials and methods. The study comprised 239 patients, included previously into randomized studies, in whom the 5 x 5 Gy radiotherapy was used. In 204 people, the surgery was made within 7 days of the completion of radiotherapy (group A). The remaining group of 35 patients were operated on after 4–8 weeks (group B). The follow-up period was 5 years. The statistical analysis was made with the Kaplan-Meier test. The value of α = 0.05 was degfined as the threshold of statistical significance. Results. In both groups, there were no statistical differences between the patients operated on with the use of GRM and those operated on without the use of GRM. The analysis took into consideration the most significant parameters, which could affect the oncological results, (ypTNM, lympho-vascular invasion (LVI), blood vessel invasion (BVI). In group A, the use of GRM was connected with a lower rate of metachronic distant metastases (p = 0.002; RR 0.41; 95% CI [0.24–0.72]), the prolongation of DFS (p = 0.008; HR 2.16; 95% CI [1.20–3.83]) and of CSS (p = 0.010; HR 2.37; 95% CI [1.20–4. 67]). No such relationships were observed in group B. Conclusions. The use of GRM decreases the risk of distant metastases and has an influence on the prolongation of recurrence free survival, but only when surgery is carried out within 7 days of the completion of irradiation.

Does routine topical antimicrobial administration prevent sternal wound infection after cardiac surgery?

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was 'Does routine topical antimicrobial administration prevent sternal wound infection (SWI) after cardiac surgery? Altogether >238 papers were found using the reported search, of which 11 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Several different antimicrobial agents, dosages and application protocols were found in the literature. Regarding topical vancomycin use, a meta-analysis by Kowalewski et al. demonstrated a 76% risk reduction in any SWI. Collagen-gentamicin sponge application was associated with a 38% risk reduction in SWI in another meta-analysis by Kowalewski et al., which included 4 randomized control trials and >23 000 patients. Lower evidence observational studies found benefit in the use of different regimes, including: combination of vancomycin paste and subcutaneous gentamycin; combined cefazoline and gentamicin spray; isolated cefazolin; bacitracin ointment; and rifampicin irrigation. We conclude that, in light of the body of evidence available, topical antibiotic application prevents SWI, including both superficial and deep SWI. The strongest evidence, derived from 2 meta-analyses, is related to the use of gentamicin-collagen sponges and topical vancomycin. Heterogeneity throughout studies regarding antibiotic agents, dosages, application protocols and SWI definition makes providing general recommendations challenging.

A local gentamicin-collagen sponge reduces cardiovascular implantable electronic device infections and pocket hematoma

Abstract Background Implantation or replacement of cardiovascular implantable electronic device (CIED) may be associated with complications such as pocket hematoma and infections. Purpose The aim of this study is to determine whether a lyophilized collagen impact impregnated with the aminoglycoside antibiotic gentamicin, applied according to the size of pocket into the surgical wound during implantation or replacement, reduces major CIED infections and pocket hematoma 12 months after the surgical intervention. Methods We conducted a retrospective study including 1189 patients (mean age 77.45±9.83 y.o.), who underwent implantation or replacement of CIED in our center between June 2007 and November 2018. We compared 475 patients treated with the local gentamicin-collage sponge (group I) with 714 patients who did not receive it (group II). The primary endpoints were the reduction of infectious complications and pocket hematoma through 12 months of follow-up post procedure. Results Complications occurred in 127 of 1189 patients (10.68%): 102 of 1189 patients (8.58%) developed pocket hematoma, 20 of 1189 patients (1.68%) infectious events and 5 of 1189 patients (0.42%) both. Specifically, the rate of complications was lower in group I: pocket hematoma 0.63% vs 13.86% (p&amp;lt;0.001), infections 0.21% vs 2.6% (p=0.02), both 0% vs 0.7% (p=0.17). The study also shows a statistically significant major incidence of infectious complications in subjects undergoing implantation or replacement of ICD, compared to subjects undergoing implantation or replacement of PPM (5.59% vs 1.5%; p&amp;lt;0.05%). Regarding the type of intervention and the incidence of complications within the subgroups, was demonstrated a statistically significant reduction in the incidence of infections in de novo implant-group I subgroup compared to de novo implant-group II subgroup (0.5% vs 3.5%; p&amp;lt;0.05); a statistically significant reduction in the incidence of infectious complications was also observed in replacement-group I subgroup (0%) compared to replacement-group II subgroup (0% vs 1.4%; p&amp;lt;0.05). Similar results were demonstrated for the incidence of pocket hematoma, with a statistically significant reduction in de novo implant-group I subgroup compared to de novo implant-group II subgroup (0.5% vs 14.13%; p&amp;lt;0.05) and in replacement-group I subgroup compared to replacement-group II subgroup (1.4% vs 12.5%; p&amp;lt;0.05). The association between therapy and development of hematoma was not statistically significant. The association between comorbidities and infectious complications in both groups was always statistically significant. Conclusion The local gentamicin-collagen sponge is a medical device which can be used in addition to local hemostasis and prophylactic doses of systemic antibiotics, with the aim of reducing infective complications and pocket hematoma after permanent CIED implantation or replacement. Funding Acknowledgement Type of funding source: None

Ultralow anterior resection with implantation of gentamicin-collagen sponge and no defunctioning stoma: anastomotic leakage and local cancer relapse.

BackgroundAnterior resection with total mesorectal excision (TME) of ultralow rectal cancer may result in the increased risk of the anastomotic leakage (AL). The aim of this study was to evaluate the usefulness of the gentamicin-collagen sponge (GCS) for the protection against symptomatic AL and investigate association between AL and local relapse (LR).Patients and methodsA series of 158 patients with ultralow rectal cancer was studied. All the patients underwent R0 sphincter-saving TME with anastomosis wrapping using GCS. In none of the cases a temporary protective stoma was constructed.ResultsAL rate was 3.2% (5/158) while median time to AL diagnosis was 5 days following surgery (range 3-15). There was no postoperative and leakage-related mortality. Patient age > 75 years and smoking were independent risk factors related to significantly increased AL rate: 12.5% vs. 0.8% (P = 0.0004) and 5.7% vs. 0% P = 0.043), respectively. LR was observed in 12% of cases. It was highly significantly more common and developed earlier in patients who have had AL when compared with non-AL group: 80% vs. 9% (P = 0.00001) and 8.5 vs. 17 months (P = 0.014), respectively.ConclusionsAnastomosis wrapping with GCS after anterior resection with TME is a safe procedure resulting in the low incidence of anastomotic leakage which may be also associated with decreased risk of local relapse.

A randomized, controlled study to investigate the efficacy and safety of a topical gentamicin-collagen sponge in combination with systemic antibiotic therapy in diabetic patients with a moderate or severe foot ulcer infection

BackgroundAn adjunctive topical therapy with gentamicin-sponges to systemic antibiotic therapy might improve the healing of infected diabetic foot ulcers (DFUI).MethodsSingle-center, investigator-blinded pilot study, randomizing (1:1) the gentamicin-sponge with systemic antibiotic versus systemic antibiotics alone for patients with DFUI.ResultsWe included 88 DFUI episodes with 43 patients in the gentamicin-sponge arm and 45 in the control arm. Overall, 64 (64/88; 73%) witnessed total clinical cure, 13 (15%) significant improvement, and 46 (52%) showed total eradication of all pathogens at the final visit. Regarding final clinical cure, there was no difference in favour of the gentamicin-sponges (26/45 vs. 31/43; p = 0.16). However, the gentamicin-sponge arm tended to a more rapid healing. In multivariate analysis adjusting for the case-mix, the variable “gentamicin-sponge” was not significantly associated with “cure and improvement”. Gentamicin-sponges were very well tolerated, without any attributed adverse events.ConclusionsThe gentamicin-sponge was very well tolerated, but did not significantly influence overall cure.Trial registrationClinicalTrials.gov (NCT01951768). Date 2 April 2013.

A Randomized Controlled Trial of the Safety and Efficacy of a Topical Gentamicin-Collagen Sponge in Diabetic Patients with a Mild Foot Ulcer Infection

A Randomized Controlled Trial of the Safety and Efficacy of a Topical Gentamicin-Collagen Sponge in Diabetic Patients with a Mild Foot Ulcer Infection

A survey of practice and opinions on the use of topical antibiotics to prevent surgical site infection: more confusion than consensus

Surgical site infection (SSI) is one of the most common causes of healthcare-associated infection. Although the use of topical antibiotics to prevent SSI is not recommended by current guidelines, published studies document conflicting results and conclusions. The objectives of this survey were to: (i) determine the extent of the use of topical antibiotics to prevent SSI in clinical practice; and (ii) gather the opinions of healthcare professionals most likely to be involved in their use. A questionnaire was circulated to members of BSAC and the European Wound Management Association (EWMA). The questionnaire received 160 responses from a variety of healthcare professionals around the world. Most respondents (70%) did not have guidelines for the use of topical antibiotics for the prevention of SSI in their institution; if present, local guidance was based on national guidelines (20/31, 65%). Most respondents did not use or recommend topical antibiotics to prevent SSI; of those that did, gentamicin collagen sponges were most commonly used (24/96 responses, 25%). Over half of the surgeons (18/33, 55%) who responded to the survey did not use topical antibiotics for the prevention of SSI but, when used, contaminated surgery (8/33, 24%) was the most commonly stated indication. There are diverse opinions and practices among healthcare professionals about the use of topical antibiotics for the prevention of SSI. This considerable, and possibly inappropriate, variation in clinical practice needs to be addressed as part of antibiotic stewardship.

Can Gentamicin-collagen Sponges Prevent Seroma Formation Following Mastectomy?

BackgroundThe aim of this study was to investigate whether gentamicin-collagen (GC) sponges can lower the incidence of seroma and surgical site infections following breast cancer surgery. Patients and MethodsA retrospective cohort study was performed. Two consecutive cohorts of patients who underwent a mastectomy with or without an axillary lymph node dissection were compared. The first cohort was treated conventionally (n = 38), the second cohort received GC sponges (n = 39). Endpoints were the incidence of clinical significant seroma (CSS) and surgical site infections (SSI), the mean number of aspirations, and the mean aspirated volume. ResultsGC sponges lowered the CSS incidence from 73.7% to 38.5% (P = .002). The mean number of aspirations and the mean aspirated volume were not affected. SSI incidence was 15.8% in the conventional cohort compared with 7.7% in the GC cohort (P = .23). ConclusionApplication of GC sponges significantly lowered the incidence of CSS. The incidence of SSI was halved, although this was not significant.

Effect of chlorhexidine skin disinfection and retrosternal gentamicin sponge on post-sternotomy mediastinitis: results from a prospective controlled registry of 2340 patients

Reducing post-sternotomy mediastinitis (PSM) requires incorporating multiple methods. However, the independent effects of these measures are not well studied. To evaluate the independent effect of preoperative disinfection using isopropyl alcohol (IPA)-chlorhexidine gluconate (CHG) and the topical application of a retrosternal gentamicin collagen sponge at wound closure on reducing PSM. From October 2012 to August 2014, 2340 patients were included in this prospective, controlled registry. Patients were divided into four groups. In groups 1 and 2, the skin was disinfected with IPA, and in groups 3 and 4, the skin was disinfected with IPA-CHG. A retrosternal gentamicin collagen sponge was used in groups 2 and 4. Freedom from PSM up to the 30th postoperative day was the primary endpoint. The secondary endpoint was freedom from any surgical site dehiscence. A stepwise regression model was made to reveal the independent factors associated with lower incidence of PSM. There were significant differences in outcome among the groups (P<0.0001). Primary healing was highest in group 4 (91.4%), which showed the lowest rate for mediastinitis (0.9%). Multivariate analysis showed that the use of CHG and a gentamicin sponge was statistically significant (P=0.026 and 0.013, respectively). The other significant independent factors were valve operation (P=0.001), body mass index >30kg/m2 (P=0.001), preoperative stroke (P=0.005), and blood transfusion (P=0.022). Preoperative skin disinfection with IPA-CHG is superior to only IPA, and it should be recommended. The addition of a retrosternal gentamicin-releasing sponge further reduces the rate of mediastinitis.

A randomized controlled trial of the safety and efficacy of a topical gentamicin-collagen sponge in diabetic patients with a mild foot ulcer infection.

Objectives:The initial phase of infection of a foot ulcer in a person with diabetes is often categorized as mild. Clinicians usually treat these infections with antimicrobial therapy, often applied topically. Some experts, however, believe that mild diabetic foot ulcer infections will usually heal with local wound care alone, without antimicrobial therapy or dressings.Methods:To evaluate the potential benefit of treatment with a topical antibiotic, we performed a single-center, investigator-blinded pilot study, randomizing (1:1) adult patients with a mild diabetic foot ulcer infection to treatment with a gentamicin–collagen sponge with local care versus local care alone. Systemic antibiotic agents were prohibited.Results:We enrolled a total of 22 patients, 11 in the gentamicin–collagen sponge arm and 11 in the control arm. Overall, at end of therapy, 20 (91%) patients were categorized as achieving clinical cure of infection, and 2 (9%) as significant improvement. At the final study visit, only 12 (56%) of all patients achieved microbiological eradication of all pathogens. There was no difference in either clinical or microbiological outcomes in those who did or did not receive the gentamicin–collagen sponge, which was very well tolerated.Conclusion:The results of this pilot trial suggest that topical antibiotic therapy with gentamicin–collagen sponge, although very well tolerated, does not appear to improve outcomes in mild diabetic foot ulcer infection.

P1497Zero device-related infections in 4285 patient-years of follow-up after cardiac implantable electronic device replacement combined with topic gentamicin-collagen sponge application

P1497Zero device-related infections in 4285 patient-years of follow-up after cardiac implantable electronic device replacement combined with topic gentamicin-collagen sponge application

Gentamicin-Collagen Sponges for the Prevention of Surgical Site Infections: A Meta-Analysis of Randomized Controlled Trials.

To study the effectiveness of gentamicin-collagen sponges (GCS) for the prevention of surgical site infections (SSIs). A systematic search of the PubMed and Scopus databases was performed (up to April 2015) to identify randomized controlled trials evaluating the efficacy of GCS for the prevention of SSIs. A random effects model was applied. Twenty-one RCTs (8,472 patients) were included. Gentamicin-collagen sponges were associated with a lower risk of SSIs (risk ratio [RR] 0.65; 95% confidence interval [CI] 0.49-0.84). Based on Jadad scores, a lower risk for the development of SSI was presented in lower-quality studies (Jadad <3; RR 0.44; 95% CI 0.27-0.71), but no difference was observed in high-quality studies (Jadad ≥3; RR 0.77; 95% CI 0.58-1.02). No difference was observed in all-cause deaths in the GCS group compared with the control group (RR 0.77; 95% CI 0.56-1.06). When analyzing lower-quality studies or only clean procedures, GCS significantly reduced the risk of SSI. Further high-quality randomized studies are needed to confirm the benefit of GCS for lowering mortality rates.

Prevention of surgical site sternal infections in cardiac surgery: a two-centre prospective randomized controlled study.

Surgical site infection (SSI) of the sternum is a devastating complication in cardiac surgery. The aim of this prospective randomized controlled two-centre clinical study was to compare the use of a gentamicin-collagen sponge (Genta-Coll® resorb) and of a cyanoacrylate-based microbial skin sealant (InteguSeal®) on the SSI rate of the sternum. We analysed data from 996 consecutive patients following isolated coronary artery bypass grafting between 2012 and 2014. The patients were randomized into three groups: standard group (S-group), Genta-Coll group (G-group) and InteguSeal group (I-group). The primary study end-point was to analyse the incidence of superficial and deep sternal SSI. The secondary study end-point was to determine independent risk factors for an increased SSI rate. Of the 996 patients investigated, 332 patients were in S-group, 336 patients in G-group and 328 patients in I-group. The mean age was 67.7 ± 9.4 years, 18.6% were women and the overall SSI rate was 6.2% with 2.2% deep sternal wound infections. SSI rates were 8.3% (S-group), 5.4% (G-group) and 4.9% (I-group) (P 0.16). Multiple regression analysis demonstrated a preoperative body mass index (BMI) of >30 kg/m2 (P 0.047), re-thoracotomy for postoperative bleeding (P < 0.001) and sternum instability (P < 0.001) as independent predictors for an increased SSI rate. The application of InteguSeal® or Genta-Coll® resorb had no significant influence on the incidence of the sternal SSI rate in 996 consecutive cardiac surgery patients but demonstrated a trend towards a benefit from using these prophylactic approaches. Multiple regression analysis demonstrated a preoperative BMI of >30 kg/m2, re-thoracotomy for bleeding and sternum instability as independent predictors for an increased sternal SSI rate.

Use of gentamicin-loaded collagen sponge in internal fixation of open fractures

ObjectiveTo assess the outcome of immediate plate osteosynthesis via application of antibiotic impregnated collagen fleeces (gentamicin-collagen and antibiotic sponge) which gradually release antibiotic locally in the surgical treatment of open fractures presented to us 6 hours after injury. MethodsAll cases were treated in our tertiary level trauma center and teaching hospital including 35 patients with open fractures who were treated by immediate open reduction and plate fixation from January 2008 to August 2010. Among them, 31 patients were available for adequate follow-up and assessment. All fractures were treated by irrigation and debridement, immediate open reduction and plate fixation along with placement of antibiotic-releasing collagen fleeces around the plate just before closure of wound. Patients were assessed to determine postoperative infection, delayed union or nonunion and development of other postoperative complications. It was hypothesized that immediate plate osteosynthesis after thorough debridement and local antibiotics would give safe and acceptable clinical results in treatment of open fractures. ResultsThe 31 patients with adequate final follow-up were assessed at a mean time of 40 weeks (15-160 weeks). Most fractures united primarily in an acceptable time period according to area of involvement. Local wound complications (superficial infection and skin loss) were found in 3 patients (9.67%). Deep infection was noted in 2 patients (6.45%). None of these patients needed implant removal and both fractures united in due time. Delayed union was noted in 5 patients (16.13%). No patient progressed to nonunion or implant failure in long term follow-up. Excessive scarring was developed in 2 patients (6.45%). ConclusionsImmediate plate osteosynthesis after adequate debridement and placement of collagen film elut-ing antibiotics locally produces excellent results regarding bone union and absence of deep infections and is a safe technique in the management of open bone injuries. These sponges can be used easily with any form of internal fixation and there is no need of second surgery for the removal of these antibiotic carriers since they are bioabsorbable. Local antibiotic-impregnated collagen sponges along with systemic antibiotics for 3 to 5 days offer promising results in open fracture management.

Treatment of bisphosphonate-related osteonecrosis of the jaws - a report of seven cases.

Aim of the studyThe aim of the study was to report on seven cases of BRONJ treated with surgical debridement, oral antibiotics and gentamicin-collagen sponge (Collatamp EG) placed in the bone wound.Material and methodsSeven patients with 9 sites of BRONJ stage 2 were included in the study. Perioperative oral antibiotics, surgical debridement and/or sequestrotomy and gentamicin-collagen sponge (Collatamp EG) were used. Postoperative monitoring was carried out for the next 3 months.ResultsThree weeks after the surgery, six sites of BRONJ in five patients were treated successfully. In two patients on three sites BRONJ stage 1 was observed. Three months after surgery another two sites healed fully. In one patient there was still BRONJ stage 1, however, the area of exposed bone was visibly reduced.ConclusionsThe use of surgical debridement together with oral antibiotic therapy and collagen-gentamycin sponge indicates positive results regarding the surgical treatment of BRONJ.

Local administration of gentamicin collagen sponge in surgical excision of sacrococcygeal pilonidal sinus disease: a systematic review and meta-analysis of the literature.

Surgical site infections occur in up to 24% of patients after surgical excision of sacrococcygeal pilonidal sinus disease with primary wound closure. Local administration of antibiotics by a gentamicin collagen sponge could reduce this infection rate. The objective of this systematic review and meta-analysis was to evaluate the effect of a gentamicin collagen sponge on outcome after surgical excision in patients with sacrococcygeal pilonidal sinus disease. A structured literature search was performed in the PubMed, Embase, The Cochrane Library, and Scopus databases. Studies comparing surgical excision of sacrococcygeal pilonidal sinus disease with versus without a gentamicin collagen sponge were included. Outcome measures were surgical site infection, wound healing, and recurrence. The search strategy yielded six studies with a total of 669 patients. Three randomized controlled trials, comparing excision of pilonidal sinus disease and primary wound closure with versus without gentamicin collagen sponge, were eligible for inclusion in the meta-analysis (319 patients), demonstrating a trend towards reduced surgical site infections after administration of gentamicin collagen sponge [absolute risk reduction 20%, 95%-confidence interval (CI) 1-41%, p=0.06]. The wound healing (absolute risk reduction 22%, 95% CI 32-77%, p=0.42) and recurrence rate (absolute risk reduction 8%, 95% CI 7-22%, p=0.30) were not significantly different between both groups. Administration of a gentamicin collagen sponge after surgical excision of sacrococcygeal pilonidal sinus disease showed no significant influence on wound healing and recurrence rate, but a trend towards a reduced incidence of surgical site infections. Therefore, additional larger well-designed randomized controlled trials are required.