Methods of preoperative skin preparation in foot and ankle surgery

Author(s): Łukasz Kołodziej, Andrzej Bohatyrewicz, Tomasz Budzyński

Bacterial flora eradication from the foot, especially regarding nail fold as well as toe web spaces, that take place prior to surgery, poses tremendous difficulty. Despite the application of various substances and techniques of surgical field preparation, positive results of bacteriological cultures from are obtained in 25 to 80% of cases, thus involving greater exposure to postoperative pyogenic complications in patients subjected to foot and ankle surgery. The authors performed cultures prior to and following preparing the surgical field in subjects undergoing elective and emergent foot and ankle surgery. Incorporated into the study were 55 patients. The most common conditions to be treated surgically comprised of hallux valgus and ankle fractures. The cultures were collected from the medial nailfold of the hallux and from 3rd web space prior to and following surgical preparation. Surgical preparation was performed by scrubbing foot area with a mixture of ethanol and isopropyl (Skinsept,Ecolab). 28% of positive cultures were revealed after the preparation of the surgical field. Among the cultured bacteria Staphylococcus epidermidis and Staphylococcus hominis prevailed. The symptoms of early infection within the postoperative wound occurred in 3,6% of patients and required oral antibiotic treatment. A high prevalence of surgical field contamination that outlasts standard preparation, including the contamination with strains that form biofilm on orthopedic implants, is of particular concern in he face of the wide use of internal fixation. The authors review the techniques of surgical field disinfections with the preparations available on the market.