Abstract
The use of effective pre-operative preparation solution is an important step in limiting surgical wound contamination and preventing infection, particularly in forefoot surgery. The most effective way is unknown. In recent studies, > 70% of aerobic bacterial cultures of specimens taken from the nail folds following skin preparation with povidine iodine were positive. The aim of the study was to determine the effectiveness of pre-operative Triclosan (Aquasept) shower, skin preparation using povidone iodine and ethyl alcohol in reducing post-operative forefoot infection.
Between February 2005 and August 2005, all patients undergoing forefoot surgery under the care of the senior author were followed prospectively. There were 50 women and 10 men with an average age of 55 years (17–92 years), who underwent 92 forefoot procedures. The surgeries included 35 (38%) osteotomies, 31 (34%) arthrodeses, and 9 (10%) Morton’s neuroma excisions and 17 (18%) soft tissue procedures. As a standard protocol, pre-operatively all patients had Triclosan shower on the day of surgery, the foot/feet were painted with povidone iodine and was covered with a sterile towel in the ward. At induction, everyone received cefuroxime 1.5gm (IV); the feet were prepared using povidone iodine and then ethyl alcohol and dried. Patients were followed up in the clinic at 2weeks, 6weeks and 3months, further follow-up if necessary.
None of the patients in the study developed deep infection. Two patients required oral antibiotics for superficial infection (one pin track infection after distal inter-phalangeal joint fusion of second toe, one following scarf osteotomy)
We conclude that the method used in this study was very effective in preventing infection following forefoot surgery.
Correspondence should be addressed to: D. Singh, BOFAS, c/o BOA, The Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London WC2A 3PE.
