Descontaminação transoperatória de enxerto durante cirurgia de reconstrução do LCA

Abstract

Objective To evaluate different decontaminants for tendon grafts, proposing an antiseptic protocol for contaminated grafts. Methods A total of 25 patients were tissue donors for the study. Each participant donated a 2.5-cm tendon sample, which was divided into 5 fragments with 5 mm each during anterior cruciate ligament (ACL) reconstruction surgery. The collected material was divided into 5 groups, totaling 125 samples. In total, four fragments of each patient were placed on the operating room floor for one minute for contamination, simulating the fall of the graft on the floor during surgery. The other fragment was immediately placed in a sterile container (group 1). One of the contaminated fragments was placed in the sterile container without being previously immersed in decontaminating solution (group 2). The remaining fragments were immersed for ten minutes in decontaminating solution: 0.5% chlorhexidine (group 3), 0.9% saline (group 4) and 0.55% ortho-phthalaldehyde (group 5), and, after this time, they were individually placed in a sterile container. The samples from the 5 groups were submitted to microbiological examination. Results Bacteria were detected in 26% of the total samples in the microbiological tests, and in group 1 there was no growth of microorganisms. In group 2, bacterial growth was observed in 16 samples. Considering the evaluation of test groups 3, 4 and 5, the percentage of decontamination was higher than the growth of microorganisms in the respective cultures. Conclusion The protocol suggested by the study showed that intraoperative graft decontamination is possible.

Allograft contamination during suture preparation for anterior cruciate ligament reconstruction: an ex vivo study

“…Several studies have shown an elevated risk of infection using allografts for ACLR [11, 12], to which graft contamination could be an important contributor. Most relevant studies have evaluated accidental contamination, such as dropping on the floor and decontamination methods, such as irrigation, mechanical agitation, or soaking with disinfection solution [3, 6, 25, 28, 33, 36]. However, limited number of studies have focussed on the potential risk of contamination during normal preparation of the graft [22, 23].…”

The Practices and Attitudes of Saudi Plastic Surgeons in Managing Contaminated Autologous Grafts

“…As little as a 15-minute exposure to 10% PVP-I was found to kill 100% of human fibroblasts, and a low concentration of 1% PVP-I was toxic as well. 5 Luciano et al 6 evaluated different decontaminants for tendon grafts. They found that intraoperative graft decontamination is possible using 0.5% chlorhexidine with a rate of 100% decontamination.…”