Quantitative comparison of exposure for the posterior Judet approach to the scapula with and without deltoid takedown.

BACKGROUND: The purposes of this study are to quantify the extent of the scapula exposed and to describe the osseous landmarks within the dissection of a posterior Judet approach with and without takedown of the posterior deltoid muscle. METHODS: The posterior Judet approach using the muscular interval between the teres minor and infraspinatus muscle with and without takedown of the deltoid muscle was performed on 10 fresh-frozen cadaveric shoulders. Retractors with 2 kg of force were used at the wound margins for retraction. Upon completion of the exposure, a calibrated digital image was taken from the surgeon's perspective and specific anatomic landmarks were identified. The digital images were then analyzed with a computer software program, ImageJ (National Institutes of Health, Bethesda, MD, USA), to calculate the area (in square centimeters) of bone exposed. RESULTS: The mean area of posterior scapula exposed by the traditional Judet approach with takedown of the deltoid muscle was 30.2 cm(2) (95% confidence interval, 27.7-32.7 cm(2)) compared with 27.3 cm(2) (95% confidence interval, 24.8-29.9 cm(2)) when the deltoid was not detached (P < .0001). In all 10 cadaveric shoulders, the posterior Judet approach without takedown of the deltoid muscle allowed access to the posterior glenoid, lateral scapula border, and spinoglenoid notch. CONCLUSIONS: Although takedown of the deltoid muscle improves exposure, the posterior Judet approach without takedown of the posterior deltoid muscle allows for safe exposure to 91% of the bony scapula obtained by removing the deltoid muscle and access to the critical osseous fixation points of the posterior scapula.

Surgical attire and the operating room: role in infection prevention.

➤ Although there is some evidence that scrubs, masks, and head coverings reduce bacterial counts in the operating room, there is no evidence that these measures reduce the prevalence of surgical site infection.➤ The use of gloves and impervious surgical gowns in the operating room reduces the prevalence of surgical site infection.➤ Operating-room ventilation plays an unclear role in the prevention of surgical site infection.➤ Exposure of fluids and surgical instruments to the operating-room environment can lead to contamination. Room traffic increases levels of bacteria in the operating room, although the role of this contamination in surgical site infection is unclear.