“… • Pre-& postoperative antibiotics (2.1%). Study Name Dayton et al (2015) Consensus Panel (Expert Opinion) [ 34 ] Participants • 5 member panel of expert foot and ankle surgeons who received an invitation from the American College of Foot and ankle Surgery (ACFAS) to form part of a consensus group. Intervention • The panel worked to evaluate via email, telephone, face to face discussions the pertinent literature to antibiotic prophylaxis in foot and ankle surgery and found only 6 studies met their inclusion criteria after their literature search.…”
BackgroundWith the advent of bacterial resistance, it is important now more than ever to evaluate use of antibiotic chemoprophylaxis in foot and ankle surgery. Within this area of the body there may be less dissection, surgery time with smaller incisions and importantly smaller sizes of implanted fixation as compared to other bone and joint procedures. Our objective was to systematically evaluate the quality of evidence behind existing guidelines.MethodologyA systematic literature search was performed: MEDLINE, CINHAL, EMBASE and the Cochrane library from 1990 up to March 2018. To avoid omitting any studies on the subject, Google Scholar was also used. The inclusion criterion were studies exploring perioperative antibiotic use, postoperative infection rates in elective foot and ankle surgery and studies associated with this subject evaluating antibiotic use in clean elective foot and ankle surgery. The exclusion criterion being studies upon contaminated or dirty surgery or those which were inclusive of procedures proximal to the foot and ankle.ResultsOverall 11 studies met the inclusion criteria. From the grading of evidence, 2 level one and 4 level two studies were recognised. These studies ranked relatively highly in comparison to 5 studies that were graded as level three and level four tiers of evidence. Results of SSI rates found within this systematic review ranged from 0% to 9.4% of overall postoperative infections encountered after foot and ankle surgery in the studies analysed.ConclusionWhilst fragmented, aspects of antibiotic chemoprophylaxis are established fields in elective surgery with a growing body of evidence. Evidence for antibiotic use however, specifically within elective foot and ankle surgery, is lacking. This systematic review is a seminal paper which delivers an impression of the most influential literature within the field of foot and ankle surgery, with the aim being to entice conclusions and guide future research.
“… • Pre-& postoperative antibiotics (2.1%). Study Name Dayton et al (2015) Consensus Panel (Expert Opinion) [ 34 ] Participants • 5 member panel of expert foot and ankle surgeons who received an invitation from the American College of Foot and ankle Surgery (ACFAS) to form part of a consensus group. Intervention • The panel worked to evaluate via email, telephone, face to face discussions the pertinent literature to antibiotic prophylaxis in foot and ankle surgery and found only 6 studies met their inclusion criteria after their literature search.…”
BackgroundWith the advent of bacterial resistance, it is important now more than ever to evaluate use of antibiotic chemoprophylaxis in foot and ankle surgery. Within this area of the body there may be less dissection, surgery time with smaller incisions and importantly smaller sizes of implanted fixation as compared to other bone and joint procedures. Our objective was to systematically evaluate the quality of evidence behind existing guidelines.MethodologyA systematic literature search was performed: MEDLINE, CINHAL, EMBASE and the Cochrane library from 1990 up to March 2018. To avoid omitting any studies on the subject, Google Scholar was also used. The inclusion criterion were studies exploring perioperative antibiotic use, postoperative infection rates in elective foot and ankle surgery and studies associated with this subject evaluating antibiotic use in clean elective foot and ankle surgery. The exclusion criterion being studies upon contaminated or dirty surgery or those which were inclusive of procedures proximal to the foot and ankle.ResultsOverall 11 studies met the inclusion criteria. From the grading of evidence, 2 level one and 4 level two studies were recognised. These studies ranked relatively highly in comparison to 5 studies that were graded as level three and level four tiers of evidence. Results of SSI rates found within this systematic review ranged from 0% to 9.4% of overall postoperative infections encountered after foot and ankle surgery in the studies analysed.ConclusionWhilst fragmented, aspects of antibiotic chemoprophylaxis are established fields in elective surgery with a growing body of evidence. Evidence for antibiotic use however, specifically within elective foot and ankle surgery, is lacking. This systematic review is a seminal paper which delivers an impression of the most influential literature within the field of foot and ankle surgery, with the aim being to entice conclusions and guide future research.
“…Antibiotics were administered both pre- and postoperatively to prevent wound infection. Antibiotic treatment is essential since it has been reported that the rate of wound infection in patients with ankle fractures can reach up to 10% [ 20 , 21 ]. Fig.…”
BackgroundThe aim of this study was to introduce a novel intraoperative lateral ankle dislocation approach during surgical treatment for patients with unstable trimalleolar fractures involving posterior ankle comminuted fractures and compare its effects and safety with those with conventional approach.MethodsFrom June 2006 to June 2014, 69 patients diagnosed as unstable trimalleolar fractures involving posterior ankle comminuted fracture were included in this study. The patients were divided into intraoperative dislocating ankle group (experimental group) and conventional treatment group (control group) according to surgical modalities. The following parameters including rate of primary healing, healing time, incidence of talus necrosis, incidence of post-traumatic arthritis, functional outcomes according to Baird-Jackson classification system, and any possible complications in two groups were recorded and compared.ResultsThere were no significant differences regarding the rate of primary healing, healing time and the rate of talus necrosis in two groups (P > 0.05). The incidence of post-traumatic arthritis in experimental and control group were 0 and 24.24% (P = 0.0006), respectively. The rate of excellent and good outcomes were achieved in 91.67% in experimental group and 72.73% in control group (P = 0.038), respectively.ConclusionsThe findings suggest that the intraoperative ankle dislocation approach appears to be a promising surgical option for unstable trimalleolar fractures involving posterior ankle comminuted fracture because it can provide better functional outcomes and lower incidence of post-traumatic arthritis while not compromising primary healing and healing time.
“…In 2015, the first ACFAS CCS addressed the topic of perioperative prophylactic antibiotic use in clean elective foot surgery (1). This CCS identified 6 investigations that produced original data on perioperative antibiosis in foot and ankle surgery (248,(264)(265)(266)(267)(268) and relied heavily on 2 previously published guidelines by other medical societies (269,270).…”
Section: Direct Perioperative Considerationsmentioning
confidence: 99%
“…This document was created to serve as one of a series of clinical consensus statements (CCSs) sponsored by the American College of Foot and Ankle Surgeons Ò (ACFAS) (1,2). It is important to appreciate that consensus statements do not represent clinical practice guidelines, formal evidence reviews, recommendations, or evidence-based guidelines.…”
A wide range of factors contribute to the complexity of the management plan for an individual patient, and it is the surgeon's responsibility to consider the clinical variables and to guide the patient through the perioperative period. In an effort to address a number of important variables, the American College of Foot and Ankle Surgeons convened a panel of experts to derive a clinical consensus statement to address selected issues associated with the perioperative management of foot and ankle surgical patients.
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