A Comparison of Two Sterile Solution Application Methods During Surgical Preparation of the Hand.

PURPOSE: The purpose of this study was to determine the extent of skin coverage during surgical preparation of the hand when preparation is done by 2 different methods. We hypothesized that hand preparation with commercially available prep-stick applicators (PS) would lead to more unprepared areas (UPAs) of skin compared with immersed 4 × 4 inch sterile gauze sponges (GS) used as controls. METHODS: Sixty upper extremities of 30 healthy volunteers were used for this study. The hands were prepped by 2 fellowship trained orthopedic hand surgeons as 30 matched pairs. The experimental group was prepped using a commercially available PS (ChloraPrep, Carefusion, San Diego, CA), whereas the control group was prepared with GS immersed in the prep solution and applied manually using sterile gloves. The number and location of UPAs in the hands and wrists of volunteers after preparation were recorded. In addition, the sum of UPAs relative to the total surface area of the skin was quantified with image analysis software. RESULTS: There were a total of 77 UPAs when prepping the volunteers with PS, compared with 14 in the control hands. This difference was statistically significant. Similarly, the average percentage area of UPAs relative to the total skin surface was 0.76% (range, 0.006% to 2.15%) when using PS compared with 0.15% (range, 0.005% to 0.56%) in the controls. This difference was statistically significant. CONCLUSIONS: We identified a larger numbers of UPAs with commercially available applicator sticks compared with a control using sterile GS. CLINICAL RELEVANCE: The clinical implications of these findings are unknown.

Dorsal root ganglion axons facilitate and guide cortical neural outgrowth: In vitro modeling of spinal cord injury axonal regeneration.

BACKGROUND: Spinal cord injury (SCI) patients represent a heterogeneous group, with injuries ranging from partial compression to complete transection. Patients with complete injuries are unlikely to exhibit recovery and suffer from paralysis as well as the loss of bowel and bladder function. One treatment option is the formation of a bridge through a lesion site, whereby transplanted cells or biocompatible scaffolds guide the regenerating axons across the site of injury. Moreover, the viability of transplanted dorsal root ganglia (DRGs) into rat spinal cord has been previously demonstrated. OBJECTIVE: We aim to demonstrate the feasibility of using DRG axons as a bridging tool to help guide the axonal growth of cortical neurons. METHODS: Cortical neurons were isolated from embryonic rats and two aggregated populations were cultured at increasing distances in isolation and in a co-culture with DRG explants. Growth rates of the sprouting axons and connections between the two populations were observed over a period of twelve days. RESULTS: DRG explants demonstrated the ability to grow robust axonal connections that can connect two explants separated by up to 10 mm, however, CNAs could not achieve connections in distances greater than 2 mm. The co-culture of CNAs with DRG explants facilitated axonal growth between two populations of CNAs at distances they cannot otherwise traverse. CONCLUSIONS: Our findings support the use of DRG axons to facilitate the growth of cortical neurons in a process of axon-facilitated axon regeneration. We believe these results could have implications for the treatment of SCI.

Preoperative Sterilization Preparation of the Shoulder: A Comparative Study Evaluating Gauze Sponge and Commercially Available Applicator Prep Stick.

BACKGROUND: Surgical site infection (SSI) remains a concern in shoulder surgery, especially during arthroplasty. While many studies have explored the characteristics and efficacy of different sterilizing solutions, no study has evaluated the method of application. The purpose of this study was to compare two popular pre-surgical preparatory applications (two 4 x 4 cm gauze sponges and applicator stick) in their ability to cover the skin of the shoulder. METHODS: Two orthopedic surgeons simulated the standard pre-surgical skin preparation on 22 shoulders of volunteer subjects. Each surgeon alternated between an applicator stick and two sterile 4x4 cm gauze sponges. Skin preparation was performed with a commercially available solution that can be illuminated under UV-A light. Advanced image-analysis software was utilized to determine un-prepped areas. A two-tailed paired t-test was performed to compare percentage of un-prepped skin. RESULTS: The applicator stick method resulted in a significantly higher percentage of un-prepped skin (27.25%, Range 10-49.3) than the gauze sponge method (15.37%, Range 5-32.8, P=0.002). Based on image evaluation, most un-prepped areas were present around the axilla. CONCLUSION: Based on our findings, the use of simple gauze sponges for pre-surgical preparatory application of sterilization solution may result in a lower percent of un-prepped skin than commercially available applicator stick. Orthopaedic surgeons and operating room staff should be careful during the pre-surgical sterile preparation of the shoulder, especially the region around the axilla, in order to reduce the potential risk of surgical site infection.Level of evidence: III.