In vitro evaluation of E. coli and S. epidermidis adhesion
on dressing materials used in hypospadias repair
Mustafa Kemal Aslan
J. Sedef Göçmen
Received: 26 July 2013 /Accepted: 10 November 2013 /Published online: 30 November 2013
Springer-Verlag Berlin Heidelberg 2013
Background An in vitro study was performed to evaluate the
adherence of Escherichia coli and Staphylococcus
epidermidis to different dressing materials.
Methods Hydrophyl gauze swab (GS), sterile flax swab (FS),
and their nitrofurazone (Furacin®) absorbed forms (GSF and
FSF), sterile paraffin-covered gauze with chlorhexidine acetate
(0.5 %) (Bactigrass®, BG), and semipermeable transparent film
gauze (Tegaderm®, TG) were used in the study. A 1 cm
material was placed in culture plates, and E. coli ATCC 25922
and S. epidermidis ATCC 12228 were suspended in each plate.
After 24, 48 h, and 1 week of incubation period, colony counts
were calculated in colony-forming units (CFU) per square cen-
timeter unit. Bacterial adhesion was compared between groups,
and each dressing material was also compared for different
incubation periods (24, 48 h, and 1 week).
Results The colony counts were significantly decreased in
GSF and FSF groups (Kruskal–Wallis test, p <0.05). There
was no difference for E. coli adhesion in GS, FS, BG, and TG
groups (p >0.05). The significant difference detected for S.
epidermidis adhesion in the first 24 to 48 h could not be
detected at the end of a 1-week period. There was no statistical
difference in groups when compared for 24-, 48-h, and 1-
week periods of incubations (Wilcoxon signed-rank test, p >
0.05). In BG group, E. coli adhesion was increased, and S.
epidermidis adhesion was decreased without a significant
difference at the end of a 1-week period (p >0.05).
Conclusions Nitrofurazone absorbed sterile gauze materials
have less bacterial adhesion. In vitro adhesion of E. coli and S.
epidermidis did not differ between the 24-h and 1-week
period. E. coli adhesion to BG can be increased if the duration
of dressing prolonged up to a 1-week period.
Level of Evidence: Not ratable.
A wide variety of dressing methods and materials for hypospa-
dias repair has been introduced for purposes of immobilizing the
repair, improving tissue repair, protecting suture lines, and
preventing edema and bleeding . However, some studies
confirm that the success rate of hypospadias surgery is indepen-
dent from dressing usage. It has been suggested that dressing
should not be indicated after all hypospadias repairs . There is
no consensus on the optimum time for dressing and type of
dressing material. The incidence of postoperative wound infec-
tion after hypospadias surgery was reported in 4 % of patients
without dressing and was found comparable with the incidence
of infection with clean wounds . Also, it has been reported that
dressings removed on the second postoperative day has no
evidence of increased risk of infection . The potential disad-
vantages of dressing include infection, ischemia, inability to
inspect wound, difficulty in keeping clean, and pain during
dressing removal . Hadidi et al. suggest that wet wound due
to urine, ooze, sweat, and stools is the cause of higher incidence
of wound complications . Although several methods were
described to prevent pain during removal, the role of dressing
contamination in wound infection after hypospadias has not been
This study was presented in the Pediatric Urology Congress PEDURO
2012, on 5–7 April 2012 in Bursa, Turkey.
M. K. Aslan
Faculty of Medicine, Department of Pediatric Surgery,
Kırıkkale University, Kırıkkale, Turkey
J. S. Göçmen
Faculty of Medicine, Department of Medical Microbiology,
Başkent University, Ankara, Turkey
T. Soyer ( *)
Department of Pediatric Surgery, School of Medicine,
Kırıkkale University, 7100 Kırıkkale, Turkey
Eur J Plast Surg (2014) 37:63–68