Cranial surgery without head shaving

Tokimura, Hiroshi; Tajitsu, Kenichiro; Tsuchiya, Masahiro; Yamahata, Hitoshi; Taniguchi, Ayumi; Takayama, Kenji; Kaji, Masatomo; Hirabaru, Masashi; Hirayama, T; Shinsato, Tomomi; Arita, Kazunori

doi:10.1016/j.jcms.2009.06.003

Cited by 19 publications

(19 citation statements)

References 17 publications

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“…1). 1,[3][4][5][7][8][9][11][12][13][14][16][17][18][19][20][23][24][25]27,28 Two of these studies were RCTs (Level I evi dence). 5,8 A short overview of the included articles is pre sented in Tables 1-3, describing the following aspects: lev el of evidence; number of patients included; perioperative management regarding shampooing, disinfection, shaving, and antibiotics; and infection rates.…”

Section: Resultsmentioning

confidence: 99%

“…3,4,7,8,[11][12][13]19,20,23,24,27,28 Two of these studies focused on skull base surgery (Table 1). 7,13 In 7 studies, other procedures besides craniotomies were de scribed.…”

Section: Elective Craniotomiesmentioning

confidence: 99%

“…7,13 In 7 studies, other procedures besides craniotomies were de scribed. 3,4,11,19,24,27,28 In 2 studies, infection rates could not be calculated for craniotomies separately.…”

Section: Elective Craniotomiesmentioning

confidence: 99%

“…In another series, Kumar et al 12 described 1 wound infection (2%) after prospective investigation of wound infections following elective cranial surgery in adults at an institution with a minimal shaving policy. A recently published retrospective series 27 on shaveless cranial surgery reported an infection rate of 1% (7 of 632 patients, including 298 craniotomies). Unfortunately, infection rates could not be calculated for separate pro cedures.…”

Section: Sheinberg and Rossmentioning

confidence: 99%

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Neurosurgery and shaving: what's the evidence?

Broekman

Beijnum

Peul

et al. 2011

JNS

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M ost patients undergoing neurosurgical proce dures dread the commonly performed preopera tive hair removal. Nevertheless, many neuro surgeons insist on removing the patient's hair before sur gery. They claim that this routine prevents postoperative infections and decreases the risk of overlooking wounds or lacerations after head trauma. Moreover, they argue that preoperative hair removal facilitates accurate plan ning of the incision, attachment and/or removal of the drapes, and closure of the wound.However, since the 1980s several reports have been published indicating that preoperative shaving may in crease the risk of postoperative infections due to a change or loss of protective skin flora and/or bacterial coloniza tion of the shaved area caused by the razor-induced mi crotrauma. 21,22,28 We systematically reviewed the current literature on preoperative shaving before neurosurgical procedures, and in this study we discuss the role of shaving preced ing craniotomies, bur hole procedures, spine surgery, and implantation surgery in both adults and children. Methods Literature Search StrategyTwo reviewers (M.L.D.B. and J.v.B.) searched Pub Med, Embase, and the Cochrane Database of Systematic Reviews up to September 8, 2009, using an electronic search strategy ([ OR ] AND [ OR ]) supple mented by hand searching the bibliographies of articles re trieved by the electronic search. We restricted this review to published data. Only papers written in English, Dutch, French, or German were considered for this review. Titles and abstracts of retrieved citations were screened, and po tentially suitable studies were read in full by both review ers. Relevant data were extracted and disagreements were resolved by discussion. The following inclusion criteria were used: 1) studies reporting on consecutive patient se ries in which either one predefined preoperative shaving policy was used or in which different policies were com pared; and 2) studies describing postoperative wound in fections and other serious (infectious) complications. Critical AppraisalThe authors aimed for a critical appraisal of the ar ticles guided by a simplified classification regarding level Department of Neurosurgery, Leiden University Medical Center, Leiden, The NetherlandsMany neurosurgeons remove their patients' hair before surgery. They claim that this practice reduces the chance of postoperative surgical site infections, and facilitates planning, attachment of the drapes, and closure. However, most patients dread this procedure. The authors performed the first systematic review on shaving before neurosurgical procedures to investigate whether this commonly performed procedure is based on evidence. They systematically re viewed the literature on wound infections following different shaving strategies. Data on the type of surgery, surgery related infections, preoperative shaving policy, decontamination protocols, and perioperative antibiotics protocols were collected. The search dete...

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Section: Resultsmentioning

confidence: 99%

“…3,4,7,8,[11][12][13]19,20,23,24,27,28 Two of these studies focused on skull base surgery (Table 1). 7,13 In 7 studies, other procedures besides craniotomies were de scribed.…”

Section: Elective Craniotomiesmentioning

confidence: 99%

“…7,13 In 7 studies, other procedures besides craniotomies were de scribed. 3,4,11,19,24,27,28 In 2 studies, infection rates could not be calculated for craniotomies separately.…”

Section: Elective Craniotomiesmentioning

confidence: 99%

Section: Sheinberg and Rossmentioning

confidence: 99%

See 2 more Smart Citations

Neurosurgery and shaving: what's the evidence?

Broekman

Beijnum

Peul

et al. 2011

JNS

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show abstract

“…If electrosurgical scalpel is used for skin and soft-tissue dissection, bleeding is minimum; hence, the probability of wound infection appears to be reduced. Therefore, cranial surgery without head shaving does not increase the risk of wound infection [15].…”

Section: Discussionmentioning

confidence: 99%

Shaving Versus Depilation Cream for Pre-operative Skin Preparation

et al. 2011

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A prospective, randomised study was carried out to compare the effect of pre-operative shaving with chemical depilation on wound infection in 100 patients. It was shown that depilatory creams saved time for preoperative preparation and had an advantage in areas where shaving was difficult. The use of depilatory creams was shown to be effective, atraumatic, non-toxic and could be self-administered. Depilatory creams could be used safely on granulating wounds and did not give rise to bacterial growth. Their use was associated with a significant reduction in skin-surface bacteria and was cheaper compared with shaving. The best practice is to refrain from hair removal unless it interferes with the surgical procedure or wound closure. If hair has to be removed, it should be done using a depilatory cream. The depilatory cream has an advantage in areas which are difficult to shave or if the patient is scheduled to undergo diagnostic procedures and operations in the same area in close succession. The fight against post-operative wound infections has long been undertaken by practitioners. The authors realise that surgical-site infections are frequently caused by the bacteria commonly found on the skin; hence, reducing the number of bacteria on the skin has been a common pre-operative practice.

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