Wound Monitoring Research Articles

Wound care challenges in children and adults with spina bifida: An open-cohort study

Skin breakdown is a frequent concern for individuals with spina bifida. We explored wound incidence in patients with spina bifida and how it varies across a person's life span and functional neurologic level. We examined the settings in which skin breakdown most commonly occurred, looking for evidence of chronic, non-healing wounds. We also sought to develop criteria to improve wound monitoring. We identified reported wound episodes in an open-cohort study over a 13-year period, examining the hospital and outpatient clinical records of spina bifida patients at Children's National Medical Center (CNMC). Current age, age at wound presentation, sex, weight, functional neurologic level, wound location, setting in which the wound was acquired, the development of a chronic wound, and presence of a shunt were recorded. Of the 376 patients in our clinical population, 123 (average age: 18.8 years, range: infancy-56 years) developed a total of 375 wounds; the majority of patients who developed one wound went on to develop one or more additional wounds, and 20 patients developed chronic wounds. Our data suggest that age bracket (adolescents), wheelchair use, and bare feet, as well as possibly obesity and reduced executive functioning, are key risk factors for wound development. These findings have led to a focused effort to increase wound education and prevention. In addition we report on our early experience using a wound care specialist to champion this initiative.

Management of Aplasia Cutis Congenita of the Scalp

Aplasia cutis congenita (ACC) is a rare condition commonly affecting the scalp in which there is a focal deficiency of cutaneous tissues of varying severity ranging from an absence of skin through to full thickness defects involving deeper elements such as bone and dura. Lesions of the scalp can be associated with complications including infection, hemorrhage, thrombosis, and seizures. Opinions in the current literature regarding management of this condition are varied with both conservative and surgical management advocated. Conservative treatment consists of regular wound dressings and systemic antibiotics, while surgical management commonly involves skin grafting and local flaps. A retrospective case review was performed to audit the outcomes of patients with ACC of the scalp managed at the Women's and Children's Hospital (WCH) in Adelaide, Australia from 2002 to 2012. Cases were identified from admission coding diagnoses and data was retrieved from patient case notes. Seventeen cases of ACC were identified. The most common location involved was the scalp vertex. Thirteen patients were managed conservatively and 4 had primary surgical intervention. Of the cases that were managed with primary surgery, 2 had complications. None of the conservatively managed patients had complications in the acute setting. At the WCH, we advocate adopting a conservative approach to management of ACC of the scalp. Defects can be successfully managed with a combination of regular dressings and systemic antibiotics. Regular wound monitoring is essential to detect any complications early to instigate appropriate treatment and determine the need for emergency surgical management.

Thin, Flexible Sensors and Actuators as ‘Instrumented’ Surgical Sutures for Targeted Wound Monitoring and Therapy

Sutures are among the simplest and most widely used devices in clinical medicine. All existing synthetic and natural forms use thread-like geometries, as purely passive, mechanical structures that are fl exible and resilient to tensile stress. Several recent reports describe strategies to incorporate advanced functionality into this platform through the employment of shape-memory polymers that offer mechanical actuation or through the release of bioresorbable compounds that carry growth factors and antibiotics to accelerate healing. [ 1–3 ]

Analysis of human skin tissue by millimeter‐wave reflectometry

Millimeter-wave reflectometry is a potentially interesting technique to analyze the human skin in vivo in order to determine the water content locally in the skin. Purpose of this work is to investigate the possibility of skin-tissue differentiation. In addition, it addresses the influence of the pressure of the probe on the skin, the influence of an air gap between probe and skin as well as the influence of a bandage between probe and skin. Reflection coefficients at various positions on the skin are measured in the 40-60 GHz range and the examined effects are quantified in terms of magnitude and phase of the reflection coefficient. Also, the possibility to perform tissue differentiation is quantified. It is indicated that differentiation of skin tissue can be performed on the basis of the magnitude of the reflection coefficient provided that no air gap exists between probe and skin. The influence of probe pressure can be substantial, in particular for phase measurements. The presence of an air gap between probe and skin reduces the differentiation capability of the considered measurement technique, whereas a bandage between probe and skin did not significantly affect the differentiation power. The results of this work confirm the potential of millimeter-wave reflectometry for determination of the water content in skin tissue which may lead to interesting applications as early detection of skin cancer and through-bandage monitoring of wounds.

Miniaturized textile-based multi-layer ph-sensor for wound monitoring applications

Abstract: Wound assessment has become an important issue in the wound treatment procedure. One important indicator of the wound status is the pH value. Our approach to assess this quantity is through use of a fiber sensor coated with a pH-responsive hydrogel, which functions as a sensitive layer for impedance measurements. An advantage of this is its integratability into wound dressings using standard textile technologies. The pH characteristic shows a pH-dependent behavior of the absolute impedance at certain frequencies. The fabrication technology and sensor characteristics are discussed. The values of almost 14% impedance change demonstrate the potential for improvement by optimizing fabrication technologies. The presented sensor meets all requirements necessary for wound pH assessment

Rapid duplex immunoassay for wound biomarkers at the point-of-care

In this study we describe a novel method of sampling and quantifying wound biomarkers for clinical settings. We believe the chosen format will allow rapid assessments of wound healing and provide biomarker evidence-based decision points for treatment of the wound at the time of presentation. The wound monitoring principle uses a proprietary sample collection tool (a thermally reversible hydrogel) to sample and isolate biomarkers within a wound environment without further sample extraction/preparation steps. We show how gel samples can be analysed in a lateral flow assay format utilising fluorescent microspheres with optically discrete emission characteristics and demonstrate quantitative detection of two analytes (duplexing) achieved in a single test line. As a model assay, the chronic wound biomarkers interleukin 6 (IL6) and tumour necrosis factor alpha (TNFα) are used. Limits of detection of 48.5pg/mL and 55.5pg/mL respectively in hydrogel samples and 7.15pg/mL and 10.7pg/mL respectively in plasma are reported. We believe this is the first literature example of quantitative detection of multiple analytes within a single test line using spectral separation to distinguish the analytes.

Wound Closure and Wound Monitoring in Total Hip Arthroplasty. An Overview

Wound closure in primary and revision total hip arthroplasty is an essential and crucial step of the procedure. A recently published meta-analysis comparing metallic staples and sutures with stitches in hip procedures revealed that the risk of infection was four times greater when staples were used. This statement created concern among orthopaedic surgeons. The aim of this overview is to address the problem of THA wound closure and wound monitoring. Further well designed, randomised, controlled trials comparing staples vs traditional stitches and eventually vs skin adhesive are necessary in order to draw conclusions in elective THA, revision surgery and hip fractures. Orthopaedic surgeons need to have more evidence in order to be able to justify their method of wound closure. Monitoring of the wound by the surgeon in the postoperative period is recommended.

Lessons learnt from two pediatric motor vehicle accidents resulting in anal canal, rectal and gluteal muscle wrenching

Ano-rectal trauma is common in motor vehicle accidents involving children. Inadequate initial assessment of the extent of lesions may be life threatening. We describe two cases where children were struck by buses that subsequently rolled over them in the prone position, resulting in ano-rectal and gluteal muscle wrenching. The first patient was inadequately assessed. Initial management did not include a diverting stoma, leading to life-threatening necrosis and septic shock. The second benefitted from our previous experience and recovery was uneventful. The distinctive mechanism of trauma in true gluteal muscle and anal canal wrenching is discussed. Gluteal muscle, anal canal and rectal wrenching as a result of rolling force from a motor vehicle is a very serious condition requiring immediate intestinal diversion with a stoma. Immediate repair may be attempted at the same time as stoma creation if the patient is stable. Broad-spectrum antibiotics and close wound monitoring are necessary to avoid muscle necrosis and serious complications.

Remote Wound Monitoring of Chronic Ulcers

Chronic wounds or ulcers are wounds that do not heal in the usual manner. This type of wound is most common in the elderly and in paraplegic patients with an estimated 1% of the population suffering from leg ulcers and the costs adding up to 4% of the annual National Health Service budget in the U.K. There is an identified need to develop a device capable of remote wound monitoring that enables patients to take charge of their wound management under clinical guidance. A new ¿wound mapping¿ device has been developed, which is based on electrical impedance spectroscopy and involves the multifrequency characterization of the electrical properties of wound tissue under an electrode array. A key feature of the prototype device is the anticipated incorporation of the measuring array into standard commercial occlusive dressings, thereby protecting the wound from interference and contamination, and thus, promoting wound healing, while monitoring the protected wound. Further development is planned including wireless transmission, thus enabling telewound monitoring as described earlier.

Novel lamination and interconnection technologies demonstrated in a flexible modular optical sensor array for wound monitoring

Flexible electronics is an emerging technology with all-printed cost effective, smart electronic products that will find a wide range of applications in large quantities in our society. Such products will be based on low-cost substrate materials like PEN or PET foils. Building of these printed electronic products is preferably done by combining foils with different functionalities through lamination and interconnection technology. This allows separate functional foils, made using mutually incompatible processing steps, to be combined and also allows independent optimisation of the foils. The current paper describes a novel lamination and interconnection process which uses low-cost solid state adhesive films for the structural bonding and isotropic conductive adhesives for the electrical interconnects. It is shown that the process allows the manufacture of interconnected foils which have a good flexural reliability we demonstrate the process by manufacturing a flexible modular optical sensor for wound monitoring.

Evaluation of distracted mandibular bone using computed tomography scan and ultrasonography: technical note

Distraction osteogenesis is considered an important reconstruction armamentarium in the management of mandibular deformities and deficiency disorders. The duration of the consolidation period is still a debatable issue among the clinicians. Evaluation of the newly formed bone is the cornerstone for terminating the consolidation period safely. The aim of this study is to find a more conservative protocol for the evaluation of callus distraction by monitoring bone healing using two different examination tools: ultrasonography and dental CT. Four adult patients (three women and one man) underwent mandibular distraction (using two intraoral and two extraoral devices). The latency period was 5-7 days and the distraction was at a rate of 2 mm per day, with 12-14 weeks of consolidation. All patients were evaluated during activation, 3 months, 6 months and 1 year post-distraction. Evaluation included clinical examination, plain radiographs, CT and ultrasonography examinations. Ultrasonographic examination of the healing callus revealed four different phases of maturation. These phases were similar to the degree of tissue calcification as measured by CT. Tissue density across the distraction wound at the time of distractor removal (12-14 weeks) was equal to or less than one-third of normal bone density. Clinical monitoring of mandibular distraction wounds can be successfully achieved through frequent use of ultrasonographic examinations. Standardization of ultrasonography based on CT findings will expand the reliability of ultrasound in monitoring callus maturation. An algorithm for evaluation of distraction wound healing is suggested.

Papers Presented at the 2007 Meeting of the Musculoskeletal Infection Society: Editorial Comment

Surgical site infections (SSI) are the third most common nosocomial infection in the United States and are associated with substantial morbidity, mortality and expense. These infections account for 38% of the infections affecting the 27 million patients who undergo surgery each year. The Joint Commission has identified nosocomial infection rates as an indicator of quality care and a reliable measure of institutional quality assurance. In addition, an increasing number of health plans are now using cost-of-care data (SSI) to profile physicians for network selection. “Report cards” containing these profile results are posted on health plan Web sites with the intent to incentivize patients to seek care only from “profile-favorable” physicians. This has led the American public to believe surgical infections are potentially preventable (unless proven otherwise). In 2006, the Institute of Medicine report “Rewarding Provider Performance: Aligning Incentives in Medicare” (September 2006) recommended pay for performance (P4P) programs as an “immediate opportunity” to align incentives for performance improvement. Shortly thereafter, legislature required the Centers for Medicare & Medicaid Services (CMS) to adopt this approach for Medicare. Despite a system-wide concern over the choice and validity of measurements used to ascertain “improvement,” more than half of commercial health maintenance organizations currently have P4P systems in place. As the categories of providers (clinicians, hospitals, and other health care facilities), numbers of measures, and dollar amounts at risk have increased, we are to be held more accountable than ever before. This month, CORR features scientific papers presented at the 17th annual meeting of the Musculoskeletal Infection Society of North America held in San Diego, California. The theme of the congress was “The Prevention and Treatment of Surgical Site Infections.” The first six papers in this symposium address SSI prophylaxis: patient selection, asepsis, and perioperative wound monitoring. The molecular biology evidenced by FDG-PET Scans has been found useful in the differentiation of septic and aseptic prosthetic loosening. Two large, prospective, total joint series have documented a substantial decrease in surgical site infections following protocols to decolonize patients harboring virulent Staphylococcal pathogens in their anterior nares. Nosocomial colonization of one healthcare center was itself the source for an outbreak of infections caused by multidrug-resistant organisms in military wounds. Lastly, postoperative hematoma formation and persistent wound drainage have been correlated with an increase in SSI following total joint arthroplasty. Three papers were selected from the basic science forum on the topic of antibiotic delivery systems. McLaren et al. further clarify the release potential of hand-made, acylic, antibiotic beads. Then chitosan, made from the shells of crustaceans, has been introduced as a antibiotic-delivery vehicle due to its film-forming properties, biocompatibility and slow biodegradation. Until recently, the inability to incorporate certain drugs into biodegradable beads has limited the arsenal available for treating multidrug-resistant, Gram positive pathogens such as methacillin resistant Staphylococcus aureus (MRSA) and vancomycin resistant Enterococcus (VRE); the authors of “Activity of Eluted Daptomycin from Calcium Sulfate Against Two Strains of Staphylococcus” disclose a clever method to incorporate daptomycin into calcium sulfate pellets using commercially available OsteoSet® kits. The last four papers link a timely diagnosis, appropriate treatment and predictable outcomes with new information regarding the natural history of specific musculoskeletal infections: septic arthritis of the ankle and the shoulder; polymicrobial prosthetic joint infections; and thigh pyomyositis. Segues of such “evidence” to newer, specific nuances of therapy shall further serve to justify our investigations with logical conclusions. We are being held responsible. Orthopaedic surgeons are under particular scrutiny: our operations are growing more and more complex; we are experiencing a higher incidence of patients compromised with significant comorbidities; the use of surgical implants is on the rise. The increased focus on quality measures, including the implementation of the Surgical Care Improvement Project, will soon bring discussions on musculoskeletal infection to the forefront. With the high cost of health care, increased patient awareness, escalating medico-legal issues and insurance pressures, the medical community must advocate patient safety and make every effort to support “best practices.”

Development of conducting polymer sensor arrays for wound monitoring

A study of conducting polymer sensors for use in monitoring the headspace of metabolites produced from superficial wounds and bums is in progress. Gas chromatography-mass spectrometry (GC-MS) headspace analysis of the most common bacterial species found to be present in wounds has been achieved to determine the key volatile markers for sensor detection. A preliminary study of sensor arrays using seven pure volatiles known to be produced from the bacteria studied is reported [R.A. Allardyce, V.S. Langford, A.L. Hill, D.R. Murdoch, Detection of volatile metabolites produced by bacterial growth in blood culture media by selected ion flow tube mass spectrometry (SIFT-MS), J. Microbiol. Methods 65 (2) (2006) 361-365; R.J. Wiggins, M. Wilks, S. Tabaqchali, Analysis by gas liquid chromatography of production of volatile fatty acids by anaerobic bacteria growth on solid medium, J. Clin. Pathol. 38 (1985) 933-936]. The sensors used were based on an existing sensor array, previously used in a smart fire detection system [E. Scorsone, A.M. Pisanelli, K.C. Persaud, Development of an electronic nose for fire detection, Sens. Actuators B: Chem. 116 (2006) 55-61], and a sensor array developed from the same design and configuration has given stable results, especially towards butyric acid and ethanol. (c) 2008 Elsevier B.V. All rights reserved.

Correlation of Risk and Postoperative Assessment Methods in Wound Surveillance

Various surveillance methods have been described for surveillance of surgical site infections (SSI). The aim of this study was to examine practicality of SSI risk assessment methods (Study on the Efficacy of Nosocomial Infection Control [SENIC] and National Nosocomial Infections Surveillance [NNIS]) with a postoperative wound monitoring scale (ASEPSIS) as an outcome assessment measure. Patients were followed with a prospective data chart from January 1, 2003, to December 31, 2005. Correlation of SENIC and NNIS together with ASEPSIS were performed. During the study period, 222 SSI occurred. SSIs were determined within the 21-d period after operations. Correlation between SENIC with ASEPSIS (r(s) = 0.47, P < 0.001) was found better than that for NNIS with ASEPSIS (r(s) = 0.41, P < 0.001). Type of operation (emergency versus elective), body mass index, operation class, and American Society of Anesthesiologists scores were found independently predictive factors for SSI. This study indicates weak but significant correlation between preoperative risk assessment methods for SSI and ASEPSIS.

Prediction of monitoring data for 239Pu accidentally injected via wound site based on the proposed NCRP wound model

In response to the consultation from the National Council on Radiation Protection and Measurements (NCRP) to the International Commission on Radiological Protection (ICRP) committee 2, retention and excretion of 239Pu deposited at wound site were calculated by coupling together the proposed NCRP wound model and the current ICRP systemic model of Pu. The physicochemical forms considered were the soluble form categorized into 'Strong Retention', and the colloidal, particulate and fragmentary forms. The results are summarized as follows. If in soluble form, immediate medical intervention is needed to prevent uptake of radionuclides to body tissues, and prompt wound monitoring is essential for an accurate estimation of the initially deposited radioactivity. If in particulate form, a multi-component exponential equation leads to an overestimation of the absorption rate to blood because of significant lymph node drainage. The committed doses in the organs for direct transfer of 239Pu to the blood may be applied to every cases of accidental injection except for fragments.

The 2003 Carl A Moyer Award: real-time metabolic monitors, ischemia-reperfusion, titration endpoints, and ultraprecise burn resuscitation.

Real-time metabolic monitoring of varied vascular beds provides the raw data necessary to conduct ultraprecise burn shock resuscitation based on second-by-second assessment of regional tissue perfusion. It also illustrates shortcomings of current clinical practices. Arterial base deficit was continuously monitored during 11 clinical resuscitations of patients suffering burn shock using a Paratrend monitor. Separately, in a 30% TBSA rat burn model (N = 70), three Paratrend monitors simultaneously recorded arterial blood gas and tissue pCO2 of the burn wound and colonic mucosa during resuscitation at 0, 2, 4, 6, and 8 ml/kg/%TBSA. Paratrend data were analyzed in conjunction with previously reported laser Doppler images of actual burn wound capillary perfusion. With current clinical therapy, continuous monitoring of arterial base deficit revealed repetitive cycles of resolution/worsening/resolution during burn shock resuscitation. In the rat model, tissue pCO2 in both burn wounds and splanchnic circulation differed depending on the rate of fluid resuscitation (P <.01 between sham and 0 ml/kg/%TBSA and between 2 ml/kg/%TBSA and 4 ml/kg/%TBSA). Burn wound pCO2 values correlated well with laser Doppler determination of actual capillary perfusion (rho = -.48, P <.01). The following conclusions were reached: 1). Gratuitous and repetitive ischemia-reperfusion-ischemia cycles plague current clinical therapy as demonstrated by numerous "false starts" in the resolution of arterial base deficit; 2). in a rat model, real-time monitoring of burn wound and splanchnic pCO2 demonstrate a dose-response relationship with rate of fluid administration; and 3). burn wound and splanchnic pCO2 are highly correlated with direct measurement of burn wound capillary perfusion by laser Doppler imager. Either technique can serve as a resuscitation endpoint for real-time feedback-controlled ultraprecise resuscitation.

Utility of Gram stain for the microbiological analysis of burn wound surfaces.

Surface swab cultures have attracted attention as a potential alternative to biopsy histology or quantitative culture methods for microbiological burn wound monitoring. To our knowledge, the utility of adding a Gram-stained slide in this context has not been evaluated previously. To determine the degree of correlation of Gram stain with culture for the microbiological analysis of burn wound surfaces. Prospective laboratory analysis. Urban health region/centralized diagnostic microbiology laboratory. Burn patients hospitalized in any Calgary Health Region burn center from November 2000 to September 2001. Gram stain plus culture of burn wound surface swab specimens obtained during routine dressing changes or based on clinical signs of infection. Degree of correlation (complete, high, partial, none), including weighted kappa statistic (kappa(w)), of Gram stain with culture based on quantitative microscopy and degree of culture growth. A total of 375 specimens from 50 burn patients were evaluated. Of these, 239 were negative by culture and Gram stain, 7 were positive by Gram stain only, 89 were positive by culture only, and 40 were positive by both methods. The degree of complete, high, partial, and no correlation of Gram stain with culture was 70.9% (266/375), 1.1% (4/375), 2.4% (9/375), and 25.6% (96/375), respectively. The degree of correlation for all 375 specimens, as expressed by the weighted kappa statistic, was found to be fair (kappa(w) = 0.32).Conclusion.-The Gram stain is not suitable for the microbiological analysis of burn wound surfaces.

Utility of Gram Stain for the Microbiological Analysis of Burn Wound Surfaces

Abstract Context.—Surface swab cultures have attracted attention as a potential alternative to biopsy histology or quantitative culture methods for microbiological burn wound monitoring. To our knowledge, the utility of adding a Gram-stained slide in this context has not been evaluated previously. Objective.—To determine the degree of correlation of Gram stain with culture for the microbiological analysis of burn wound surfaces. Design.—Prospective laboratory analysis. Setting.—Urban health region/centralized diagnostic microbiology laboratory. Patients.—Burn patients hospitalized in any Calgary Health Region burn center from November 2000 to September 2001. Intervention.—Gram stain plus culture of burn wound surface swab specimens obtained during routine dressing changes or based on clinical signs of infection. Main Outcome Measures.—Degree of correlation (complete, high, partial, none), including weighted κ statistic (κw), of Gram stain with culture based on quantitative microscopy and degree of culture...

Real-Time Metabolic Monitors, Ischemia-Reperfusion, Titration Endpoints, and Ultra-Precise Burn Resuscitation

Journal Article Real-Time Metabolic Monitors, Ischemia-Reperfusion, Titration Endpoints, and Ultra-Precise Burn Resuscitation Get access T. D. Light, MD, T. D. Light, MD 1Washington Hospital Center, Washington, DC2MedStar Research Institute, Washington, DC3Uniformed Services University of the Health Sciences, Bethesda, MD Search for other works by this author on: Oxford Academic Google Scholar J. C. Jeng, MD, FACS, J. C. Jeng, MD, FACS 1Washington Hospital Center, Washington, DC2MedStar Research Institute, Washington, DC3Uniformed Services University of the Health Sciences, Bethesda, MD Search for other works by this author on: Oxford Academic Google Scholar A. K. Jain, MS, A. K. Jain, MS 1Washington Hospital Center, Washington, DC2MedStar Research Institute, Washington, DC3Uniformed Services University of the Health Sciences, Bethesda, MD Search for other works by this author on: Oxford Academic Google Scholar D. E. Kim, MD, D. E. Kim, MD 1Washington Hospital Center, Washington, DC2MedStar Research Institute, Washington, DC3Uniformed Services University of the Health Sciences, Bethesda, MD Search for other works by this author on: Oxford Academic Google Scholar T. M. Phillips, MD, T. M. Phillips, MD 1Washington Hospital Center, Washington, DC2MedStar Research Institute, Washington, DC3Uniformed Services University of the Health Sciences, Bethesda, MD Search for other works by this author on: Oxford Academic Google Scholar A. G. Rizzo, MD, FACS, A. G. Rizzo, MD, FACS 1Washington Hospital Center, Washington, DC2MedStar Research Institute, Washington, DC3Uniformed Services University of the Health Sciences, Bethesda, MD Search for other works by this author on: Oxford Academic Google Scholar M. H. Jordan, MD, FACS M. H. Jordan, MD, FACS 1Washington Hospital Center, Washington, DC2MedStar Research Institute, Washington, DC3Uniformed Services University of the Health Sciences, Bethesda, MD Search for other works by this author on: Oxford Academic Google Scholar The Journal of Burn Care & Rehabilitation, Volume 24, Issue suppl_2, March-April 2003, Page S61, https://doi.org/10.1097/00004630-200303002-00037 Published: 01 March 2003

Methicillin-resistant Staphylococcus aureus Infection Does Not Adversely Affect Clinical Outcome of Lower Extremity Amputations

Methicillin-resistant Staphylococcus aureus was first identified in isolation in Europe during the 1960's. Now widespread throughout the world, infection with this organism has emerged as a major problem in surgical practice. However, it remains debatable whether MRSA is more virulent than methicillin-susceptible strains. We have reviewed our most recent 4-year experience of lower extremity amputations to examine the influence of MRSA and non-MRSA infection on clinical outcome. During the past 4 years, 165 patients underwent lower extremity amputation for SVS/ISCVS category III acute limb ischemia and grades II and III chronic limb ischemia. Forty-five had documented MRSA infection, while 57 patients had documented infection with other flora. All patients were treated with appropriate sensitivity-specific antibiotics and aggressive wound care. No significant differences were noted in the level of primary amputation required by the two groups. Similarly, no significant differences were noted in either number of revisions or revision to higher-level amputation, time to heal, hospital length of stay, or 30-day morbidity and mortality rates. Our results demonstrate that MRSA infection does not adversely affect clinical outcome in patients undergoing lower extremity amputations. Appropriate treatment of infections with sensitivity-specific antibiotics, thorough wound debridement, and aggressive wound monitoring should be routine in all patients, regardless of bacterial flora.