Ismay Fabre

Miss Ismay Fabre, Core Surgical Trainee, Health Education and Improvement Wales

Ismay is a Core Surgical Trainee interested in pursuing a career in Vascular Surgery. Prior to her current role, Ismay completed a Clinical Research Fellow job in the Aneurin Bevan Health-board, which inspired her to engage in further research and academia alongside her clinical training.

At present, Ismay is actively involved with SIMBA; a multicentre, international audit, run with the support of the Vascular and Endovascular Research network, regarding surgical site infections after major lower limb amputations.

Presentation at The SoTV/EWMA 2024 Conference, London

Surgical Site Infection In Lower Limb Amputations (SIMBA).

Learning objectives

After attending this session, persons will be able to:

  • Discussion regarding the burden and incidence of surgical site infections in major lower limb amputations.
  • An overview of the SIMBA audit


Background: Over 3,000 major lower limb amputations (MLLA) occur in the UK per annum. A significant proportion of patients following MLLA will go on to develop a surgical site infection (SSI). SSIs can range from a simple, superficial infection that is treated with oral antibiotic therapy to deeper infections which can lead to wound dehiscence and ultimately, surgical revision. SSIs can have a significant impact on patient mobility, function, morbidity, and mortality as well as wider effects on carers, community services and hospital systems. Despite these potential impacts there are limited data to determine the rate of SSI in patients undergoing MLLA, adjuncts that successfully prevent SSI, factors that predispose patients to SSI and compliance with national guidance set out by key stakeholders in vascular surgical care.

Methods: To address this gap in evidence we propose a large, international, prospective, collaborative audit that aims to compare current practice against recommendations set out by the National Institute of Health and Care Excellence and The Vascular Society of Great Britain and Ireland and to determine the frequency of significant outcomes related to SSI (as defined by the Centre for Disease Control) in consecutive patients undergoing MLLA over an eight month period including; incidence of SSI, wound dehiscence and surgical revision at 30 days, frequency of use of adjuncts designed to reduce SSI and predictors of SSI. Outcomes will also be captured at 1 year post-MLLA if funding permits.

Discussion: This multicentre audit will allow us to describe the incidence and burden of SSI and wound dehiscence in patients undergoing MLLA. The strengths of this audit will lie in its use of contemporaneous data collection from numerous hospitals, and the in-depth data collection focussing primarily on MLLA SSI. It is anticipated that the audit will provide impactful data for future comparisons with global practice and support the design of robust and meaningful studies.