ABSTRACT
AIMS: The aim of this study was to determine whether the sequential application of povidone iodine-alcohol (PVI) followed by chlorhexidine gluconate-alcohol (CHG) would reduce surgical wound contamination to a greater extent than PVI applied twice in patients undergoing spinal surgery. PATIENTS AND METHODS: A single-centre, interventional, two arm, parallel group randomised controlled trial was undertaken, involving 407 patients who underwent elective spinal surgery. For 203 patients, the skin was disinfected before surgery using PVI (10% [w/w (1% w/w available iodine)] in 95% industrial denatured alcohol, povidone iodine; Videne Alcoholic Tincture) twice, and for 204 patients using PVI once followed by CHG (2% [w/v] chlorhexidine gluconate in 70% [v/v] isopropyl alcohol; Chloraprep with tint). The primary outcome measure was contamination of the wound determined by aerobic and anaerobic bacterial growth from samples taken after disinfection. RESULTS: The detection of viable bacteria in any one of the samples taken after disinfection (culture-positive) was significantly lower in the group treated with both PVI and CHG than in the group treated with PVI alone (59 (29.1%) versus 85 (41.7%), p = 0.009; odds ratio 0.574; 95% confidence interval, 0.380 to 0.866). CONCLUSIONS: Antisepsis of the skin with the sequential application of PVI and CHG more effectively reduces the contamination of a surgical wound than PVI alone. Cite this article: Bone Joint J 2017;99-B:1354-65.
Subject(s)
Antisepsis/methods , Chlorhexidine/analogs & derivatives , Ethanol/administration & dosage , Neurosurgical Procedures , Povidone-Iodine/administration & dosage , Preoperative Care/methods , Surgical Wound Infection/prevention & control , Administration, Topical , Anti-Infective Agents, Local/administration & dosage , Chlorhexidine/administration & dosage , Drug Administration Schedule , Drug Combinations , Female , Humans , Male , Spinal Diseases/surgeryABSTRACT
Graft extrusion following anterior cervical discectomy is a recognized complication. We report a case of acute laryngeal obstruction secondary to synthetic graft extrusion to highlight potential dangers of interbody spacing devices and to stress the importance of investigation of patients who have symptoms attributable to early graft extrusion.
Subject(s)
Bone Transplantation/adverse effects , Cervical Vertebrae/surgery , Diskectomy , Foreign-Body Migration/complications , Laryngostenosis/etiology , Biocompatible Materials , Humans , Male , Middle Aged , PolymersABSTRACT
Gliomas are incurable cerebral tumours. Surgery with adjuvant therapy is aimed at achieving a maximum symptom-free period. We report a case of spontaneous regression of a cerebral oligodendroglioma following infarction in the territory of its feeding artery. Prospects of interventional technique as a part of multimodality treatment of gliomas are discussed.
