Intraoperative graft decontamination during ACL reconstruction surgery.

Objective To evaluate different decontaminants for tendon grafts, proposing an antiseptic protocol for contaminated grafts. Methods A total of 25 patients were tissue donors for the study. Each participant donated a 2.5-cm tendon sample, which was divided into 5 fragments with 5 mm each during anterior cruciate ligament (ACL) reconstruction surgery. The collected material was divided into 5 groups, totaling 125 samples. In total, four fragments of each patient were placed on the operating room floor for one minute for contamination, simulating the fall of the graft on the floor during surgery. The other fragment was immediately placed in a sterile container (group 1). One of the contaminated fragments was placed in the sterile container without being previously immersed in decontaminating solution (group 2). The remaining fragments were immersed for ten minutes in decontaminating solution: 0.5% chlorhexidine (group 3), 0.9% saline (group 4) and 0.55% ortho-phthalaldehyde (group 5), and, after this time, they were individually placed in a sterile container. The samples from the 5 groups were submitted to microbiological examination. Results Bacteria were detected in 26% of the total samples in the microbiological tests, and in group 1 there was no growth of microorganisms. In group 2, bacterial growth was observed in 16 samples. Considering the evaluation of test groups 3, 4 and 5, the percentage of decontamination was higher than the growth of microorganisms in the respective cultures. Conclusion The protocol suggested by the study showed that intraoperative graft decontamination is possible.

Intraoperative graft decontamination during ACL reconstruction surgery / Descontaminação transoperatória de enxerto durante cirurgia de reconstrução do LCA

Abstract Objective To evaluate different decontaminants for tendon grafts, proposing an antiseptic protocol for contaminated grafts. Methods A total of 25 patients were tissue donors for the study. Each participant donated a 2.5-cm tendon sample, which was divided into 5 fragments with 5 mm each during anterior cruciate ligament (ACL) reconstruction surgery. The collected material was divided into 5 groups, totaling 125 samples. In total, four fragments of each patient were placed on the operating room floor for one minute for contamination, simulating the fall of the graft on the floor during surgery. The other fragment was immediately placed in a sterile container (group 1). One of the contaminated fragments was placed in the sterile container without being previously immersed in decontaminating solution (group 2). The remaining fragments were immersed for ten minutes in decontaminating solution: 0.5% chlorhexidine (group 3), 0.9% saline (group 4) and 0.55% ortho-phthalaldehyde (group 5), and, after this time, they were individually placed in a sterile container. The samples from the 5 groups were submitted to microbiological examination. Results Bacteria were detected in 26% of the total samples in the microbiological tests, and in group 1 there was no growth of microorganisms. In group 2, bacterial growth was observed in 16 samples. Considering the evaluation of test groups 3, 4 and 5, the percentage of decontamination was higher than the growth of microorganisms in the respective cultures. Conclusion The protocol suggested by the study showed that intraoperative graft decontamination is possible.

Resumo Objetivo Avaliar diferentes descontaminantes para enxertos de tendões, propondo um protocolo de antissepsia para o enxerto contaminado. Métodos Um total de 25 pacientes foram doadores de tecido para o estudo. Cada participante doou uma amostra de 2,5 cm de tendão, a qual foi dividida em 5 fragmentos de 5 mm durante cirurgia de reconstrução do ligamento cruzado anterior (LCA). O material coletado foi dividido em 5 grupos, totalizando 125 amostras. Ao todo, quatro fragmentos de cada paciente foram colocados sobre o piso da sala cirúrgica, durante um minuto, para contaminação, simulando a queda do enxerto no chão durante o ato operatório. O outro fragmento foi, imediatamente, colocado em um recipiente esterilizado (grupo 1). Um dos fragmentos contaminados foi colocado no recipiente esterilizado sem ser previamente imerso em solução descontaminante (grupo 2). Os demais fragmentos foram imersos, por dez minutos, em solução descontaminante: clorexidina 0,5% (grupo 3), soro fisiológico 0,9% (grupo 4) e ortoftaldeído 0,55% (grupo 5), e, após esse tempo, foram colocados individualmente em um recipiente esterilizado. As amostras dos 5 grupos foram submetidas a exame microbiológico. Resultados Houve detecção de bactérias em 26% do total de amostras nos testes microbiológicos, sendo que no grupo 1 não houve crescimento de micro-organismos. No grupo 2, observou-se crescimento bacteriano em 16 amostras. Avaliando-se os grupos de teste 3, 4 e 5, o percentual de descontaminação foi superior ao crescimento de micro-organismos nas respectivas culturas. Conclusão O protocolo sugerido pelo estudo mostrou que é possível a descontaminação transoperatória do enxerto.

THIRD-DEGREE BURN IN THE REGION OF THE ELECTROSURGICAL PAD DURING SHOULDER ARTHROSCOPY: A CASE REPORT.

The number of shoulder arthroscopy procedures is increasing and, because of this, the frequency of related complications is also increasing. This report presents a case of third-degree burn from an electrosurgical pad during this procedure and serves as an alert regarding the possible causes and how to try to prevent this rare, but possible complication.

Queimadura de terceiro grau na região da placa eletrocirúrgica durante artroscopia de ombro: relato de caso / Third-degree burn in the region of the electrosurgical pad during shoulder arthroscopy: a case report

O número de artroscopias de ombro está aumentando e, por causa disso, a frequência de complicações relacionadas também aumenta. O presente caso relata uma queimadura de terceiro grau na região da placa eletrocirúrgica durante esta cirurgia e alerta sobre possíveis causas e como tentar prevenir esta rara, mas possível complicação.

The number of shoulder arthroscopy procedures is increasing and, because of this, the frequency of related complications is also increasing. This report presents a case of third-degree burn from an electrosurgical pad during this procedure and serves as an alert regarding the possible causes and how to try to prevent this rare, but possible complication.

Extravasamento de líquido no mediastino e derrame pleural durante artroscopia de ombro: relato de caso / Fluid leakage into the mediastinum and pleural effusion during shoulder arthroscopy: a case report

O presente trabalho tem o objetivo de apresentar uma rara, porém possível complicação respiratória durante uma artroscopia de ombro executada na posição de "cadeira de praia". Houve extravasamento de líquido para o mediastino durante o procedimento quando se usava a bomba de infusão, ocasionando dificuldade respiratória. O tratamento foi conservador, com retardamento da extubação, internação em unidade de terapia intensiva, diuréticos e medidas de suporte. No quarto dia de pós-operatório, a paciente estava assintomática em relação a tal complicação.

This study is intended to present a rare but possible respiratory complication during a shoulder arthroscopy performed in the beach chair position. Fluid leaked into the mediastinum during the procedure when the infusion pump was being used, which caused respiratory difficulty. Treatment was conservative, with extubation delay, stay at the Intensive Care Unit, diuretic drugs, and support action. In the fourth postoperative day, the patient was asymptomatic regarding such complication.

Complicação durante astroscopia do joelho usando bomba de infusão: relato de caso / Complication during knee arthroscopy using infusion pump: a case report

A patient was submitted to knee arthroscopy in order to perform lateral and medial partial meniscectomy. This was performed by using an arthroscopic pump. A massive amount of extravasation of irrigation fluid into the thigh, groin, scrotum, penis, and peritoneal space was noticed at the end of the procedure. Nevertheless, there was no clinical evidence of compartmental syndrome. Diuretics were administrated while the patient was kept hospitalized. The fluid was totally excreted within 48 hours. The patient suffered from no further sequelae.

Meniscectomia parcial artrocópica em pacientes acima dos 45 anos de idade / partial srthroscopic meniscectomy in patients older than 45 years of age

Num levantamento de 293 artroscopias realizadas foram encontrados 45 pacientes acima de 45 anos de idade; 39 foram reavaliados, sendo 26 homens e 13 mulheres. Todos foram operados pela mesma técnica cirúrgica artroscópica. A tática cirúrgica visou remover qualquer fragmento meniscal instável, deixando um anel meniscal firme e estável. O acompanhamento médio foi de 14 meses. Os resultados foram comparados em presença ou näo de artrose nos joelhos dos pacientes. Os autores concluem que as lesöes mensicais possivelmente sintomáticas em pacientes acima de 45 anos podem ser tratadas artroscopicamente, com bons resultados e baixa morbidade. N presença de degeneraçäo artrósica, os resultados säo menos satisfatórios mas ainda assim encorajadores