Warming the Skin of Patients Before Surgery May Decrease Wound Infection (dateline September 20, 2001)

Many patients who undergo surgery are given antibiotics prior to their operations to help reduce the risk of infections. However, British researchers have discovered that warming the skin before surgery may be a more effective method of decreasing wound infections. Warming patients helps the body fight infections naturally and could be an important finding as the resistance to antibiotics increases.

To conduct their study, Andrew C. Melling and his colleagues from the University Hospital of North Tees in the United Kingdom assigned 421 patients to receive either skin warming or no preventive measure before surgery (breast, varicose vein, or hernia). After two to six weeks post-surgery, the researchers found that the women who received skin warming prior to surgery had significantly fewer wound infections than the women who did not receive warming (an infection reduction rate of 64%).

Warming was performed one of two ways in the study: either locally to the surgical area or systemically (to the entire body). Local warming involved using an inch-high doughnut cut to the size of the incision topped with a metal card that radiated heat. This heating device was placed directly on the surgical area. Systemic warming involved placing a perforated plastic quilt on patients that blew warm air onto their bodies. The researchers did not note a difference between the two heating methods.

White blood cells kill harmful bacteria by using highly reactive oxygen. Therefore, a large amount of oxygen is needed to prevent infection. In theory, warming the skin of patients before surgery helps reduce wound infections because more oxygen can travel to the surgical site. (Normally, when surgery is performed and the body is cut, the blood vessels constrict, making it more difficult for oxygen to reach the surgical site). The skin is usually a few degrees cooler than the body. In this study, the researchers attempted to warm the patients’ skin to approximately 98 degrees—the same temperature as the body to increase oxygen in the body. Warming the skin more than 98 degrees is potentially dangerous because it increases metabolism and could cause the skin to burn.

Melling and his colleagues believe that skin warming could be a viable alternative to prophylactic (preventive) antibiotics for patients who undergo breast, varicose vein, or hernia surgery. Because of the risk of developing a resistance to antibiotics, experts say that it is sometimes difficult for antibiotics to reach the wound because the blood supply that carries the antibiotics is interrupted. Therefore, using the body’s own immune system to naturally fight infections is desirable.

The British study is one of the first to show good results with humans. However, further research is still needed before skin warming can be adopted as a standard alternative to antibiotics in preventing surgical infections.

Additional Resources and References

• The study, "Effects of Preoperative Warming on the Incidence of Wound Infection After Clean Surgery: A Randomised Controlled Study," is published in the September 15, 2001 issue of The Lancet, http://www.thelancet.com/
• The September 13, 2001 Associate Press report is entitled, "Warm Skin May Help in Surgery."
• To learn more about treatments for breast cancer, please visit http://www.imaginis.com/breasthealth/treatment.asp