Efficacy of Preoperative and Intraoperative Skin and Nail Surgical Preparation of the Foot in Reducing Bacterial Load

Author： BECERRO DE BENGOA VALLEJO RICARDO LOSA IGLESIAS MARTA ELENA ALOU CERVERA LUIS FERNÁNDEZ DAVID SEVILLANO PRIETO JOSÉ PRIETO

Publisher： Elsevier

ISSN： 1076-0512

Source： Dermatologic Surgery, Vol.36, Iss.8, 2010-08, pp. : 1258-1265

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Abstract

BACKGROUNDA common problem associated with toenail removal surgery is the accompanying bacterial infection that often ensues. The foot has a particularly difficult anatomy to prepare antiseptically for surgery, which contributes to this wide-spread problem. OBJECTIVETo compare the antiseptic efficacy of two skin pretreatment methods before toenail avulsion surgery. METHODSTwo presurgical methods were performed on 24 patients each (48 patients total). Swab samples were taken from each patient at five distinct stages (pretreatment, post-treatment, after surgery, after saline solution irrigation of the nail bed, and after phenol application) throughout the surgical procedure, and bacterial culture analysis was performed (total inocula count and identification of specific microorganisms). RESULTSWe found both methods to be effective at reducing the initial bacterial load when used at pretreatment, but the reduction in bacterial load was lost after the nail avulsion surgery, achieving values similar to the initial bacterial load before the presurgical scrub, from 5.17 and 5.04 log₁₀ colony-forming units (CFU)/cm² to 4.86 and 5.07 log₁₀ CFU/cm², respectively. An interoperative irrigation step was effective in reducing the bacterial load by 95.2% and 95.3%, respectively. STUDY LIMITATIONSOur patients underwent phenol-based nail avulsion, resulting in no bacterial load after complete nail removal because of the intrinsic antiseptic nature of the phenol. CONCLUSIONSIncorporation of intraoperative irrigation of sterile saline solution after nail avulsion surgery reduces potential bacterial load. Every effort should be made to lower the risk of contamination after nail plate avulsion.The authors have indicated no significant interest with commercial supporters.