Randomized, Prospective Study of the Order of Preoperative Preparation Solutions for Patients Undergoing Foot and Ankle Orthopedic Surgery

Abstract

Level I, prospective randomized study.

Preoperative disinfection of foot and ankle: microbiological evaluation of two disinfection methods

“…The main weakness of this study is that the direct relation between bacterial inocula and postoperative wound infections is yet to be proven. It is conceivable that reducing the bacterial load is beneficial for preventing wound complications; however, this is to be proven in clinical studies [ 15 , 16 , 26 ]. A pilot study in patients undergoing foot/ankle surgery should be the next step.…”

“…Alcohol is microbiologically the most active; it is ten times more potent than CHG and PVI when it comes in its therapeutic concentration between 70 and 90% [ 14 ]. Chlorhexidine also has a direct effect, but has, in contrast to alcohol, a longer residual effect for up to 6 h. Furthermore it is active over a wide pH (5–8) when used within the correct therapeutic concentrations (0.5–3.5%) [ 7 , 14 – 16 ]. PVI usually comes in an aqueous solution with its therapeutic concentration between 5 and 10% or between 0.5 and 1% ‘available’ iodine.…”

During Draping for Total Ankle Arthroplasty (TAA), Should the Foot Be Prepped Into the Surgical Field or Be Covered?

“…Hunter et al performed a prospective, randomized control study to assess the proper order of skin preparation of foot and ankle orthopedic surgeries. 4 The authors found that there were lower rates of positive postprocedural cultures in patients undergoing preparation with isopropyl alcohol followed by chlorhexidine compared to patients undergoing preparation with chlorhexidine followed by isopropyl alcohol. However, no assessment was performed comparing coverage versus noncoverage of the toes during the procedure.…”

Skin Preparation Techniques for Orthopedic Foot and Ankle Surgery: A Current Concepts Review

“…17 Despite this, SSIs remain one of the most common complications after foot and ankle surgery, suggesting the potential for improvement upon current skin antisepsis techniques. 22…”

“…Surgical site infection (SSI) is a serious complication following an orthopedic foot and ankle procedure, potentially contributing to morbidity, mortality, hospital readmission, and cost. 22 SSI and related wound complications can be devastating to the point that they are major contributors to the decision by many to treat injuries such as Achilles tendon ruptures nonoperatively. 46 SSI is one of the most common and severe complications following almost all foot and ankle procedures, ranging from total ankle arthroplasty 19,41 to hallux valgus correction 3,5 to ankle fracture fixation.…”