Two methods of pre-operative hair removal and their effect on post operative period

Abstract

Background: Preparation for surgery has traditionally included the routine removal of body hair from the intended surgical wound site. Hair is removed as its presence can interfere with the exposure of the incision and subsequent wound, the suturing of the incision and the application of adhesive drapes and wound dressings. Hair is also perceived to be associated with a lack of cleanliness and hair removal is thought to reduce the risk of surgical site infections (SSIs). SSIs are experienced by around 10% of patients in the UK each year and can result in delayed wound healing, increased hospital stays, unnecessary pain and in extreme cases the death of the patient. Three methods of hair removal are currently used: shaving, clipping and chemical depilation. When a surgical operation is to be conducted through a hair bearing part of the body, hair removal is often performed. Aims & Objective: This study aimed to evaluate the relationship of two methods (shaving and depilation cream) of preoperative hair removal to adequacy of hair removal, skin injury and reaction during hair removal, postoperative wound infection in a developing country where razor shaving is very popular. Material and Methods: Consecutive consenting patients scheduled to have such operations were randomized into two groups. One group had hair removal by shaving with a razor blade while the other had hair removed by depilatory cream. Adequacy of hair removal and presence of skin injuries and/or reactions were noted preoperatively. Details of the procedures were recorded and patients were then assessed for postoperative wound infection. Results: A total 215 patients were studied. Of the 103 patients who had hair removal by depilatory cream, hair was completely removed in 93 (91%) compared to 69 (62%) of the 112 patients who had razor hair shaving. Skin injuries were noted in 32 (29%) of the razor group and 4 (4%) of patients who had depilatory cream. 18 patients (8%) had postoperative wound infection including 3 (3%) in the depilatory cream group and 15 (13%) of the razor group. A significant association was found between preoperative skin injuries and postoperative wound infections. Conclusion: Preoperative hair removal with razor shaving predisposes to skin injuries which in turn significantly influence postoperative wound infection rates. Such injuries and resultant wound infection are fewer when depilatory cream is used for hair removal.