Delayed infection following axillary shoulder incisions.

Background: Although infections following shoulder surgery may be delayed beyond those seen following surgery in other joints, initial presentation of infection six months after surgery is rare. We report on unusual cases of delayed postoperative infection in patients treated through axillary incisions. Methods: Following institutional review board approval, data were collected through a retrospective chart review of all patients who underwent surgical procedures involving axillary incisions by 2 surgeons between 2013 and 2021. During this time period, 378 surgeries were performed via axillary incisions for a variety of procedures including inferior capsular shift, biceps tenodesis, and pectoralis repair. Results: Only 4 cases of infection were identified in cases utilizing an axillary incision during a 9-year period and they all presented in a delayed fashion between 7 and 32 months postoperatively. All patients ultimately cleared their infection following surgical intervention. Conclusions: Clinicians must maintain a high level of suspicion for infection in patients presenting with surgical site pain following procedures involving axillary incisions, even in the context of a delayed presentation. Arthroscopic techniques may be considered as an alternative to open procedures, when practical, to minimize the possibility of infection. In the treatment of infected cases, a concerted effort to remove all foreign materials from the surgical site during irrigation and debridement may minimize the risk of recurrent infection.