Guidelines for Complications of Cancer Treatment Vol VIII Part B

Surgical techniqueAdherence to meticulous surgical technique is essential inreducing the infection rates after joint arthroplasty.1. There is strong evidence to support the use ofimpenetrable disposable clothing and drapes, as opposedto using permeable gowns 46 .2. The operative site should be cleansed with an antisepticagent, and covered with an antiseptic adhesive tapebefore incision. A plastic drape impregnated with slowreleaseiodophor inhibits skin recolonization and lateralmigration of bacteria from scrubbed areas not involvingthe incision 25 .3. Efforts should be made to minimize the duration ofsurgery, because prolonged operative time increases therate of infection 47,48 .4. Although the method of gloving is controversial, doublegloving is still recommended over single gloving 1 . Acloth outer glove significantly reduces the number ofpunctures to the innermost glove compared with wearingdouble latex gloves 49 .5. Surgical staff should wear hoods and masks, althoughthe wearing of masks is controversial 29 .6. Gore-Tex gowns may prevent dispersion of bacteria upto 1000 times more effectively than cotton gowns 50 .7. Several operative instruments, such as suction tips andsplash basins, are reported as sources of bacterialcontamination. Frequent exchanging of the suction tip,and use of a clean suction tip at the time of preparationof the femoral canal, is recommended to minimizebacterial contamination 1 .8. In addition, delicate tissue handling and prevention ofextensive dissection from the underlying fascia helpreduce the extent of devitalized tissue 25 .131