Abstract
Background: Infection in total joint replacement remains one of the most devastating post operative complications. The majority of these infections are still caused by organisms normally found on the skin. The use of adhesive wound drapes has become commonplace in orthopaedic surgery but frequently these are detached from the wound edges at the end of surgery allowing contamination of the wound.
Aim: To develop a technique to improve the adherence of wound drapes.
Methods: The first part of this study was to experiment with a number of techniques to prepare the skin preoperatively. We were able to identify that a combination of initial Betadine in alcohol preparation, followed by re-preparation of the operative site with Chlorhexidine in alcohol produced the best combination of drape adherence. In a consecutive series of 100 patients we have used our original technique of preparing the wound for 50 patients followed by a further 50 patients prepared with the new technique.
Results: In the initial patient group all of the adhesive drapes were detached enough to expose the skin edges in at least one part of the wound by the end of the surgical procedure. With the new technique we have had no detachments of the adhesive drape.
There have been no complications or skin reactions related to this method of skin preparation. There has been no significant difference in the incidence of early post operative wound infection.
Conclusion: This technique of operation site preparation provides an excellent means of preventing detachment of adhesive wound drapes. We have found it reliable, safe and effective to date and it adds little to the overall procedure time. We recommend this technique as a way of ensuring that the skin edges remain covered throughout primary and revision procedures.
Editoral Secretary Mr Peter Howard. Correspondence should be addressed to BHS at the Royal College of Surgeons, 35 - 43 Lincoln’s Inn Fields, London WC2A 3PN.
