SLR - August 2011 - Chuck Hoehn
Reference: Vallejo, R.B., Iglesias, M.E., Cervera, L.A., Fernandez, D.S., Prieto, J.P. (2011). Efficacy of Intra-Operative Surgical Irrigation with Polihexanide and Nitrofurazone in Reducing Bacterial Load after Nail Removal Surgery. Journal of the American Academy of Dermatology, Inc. (American), February 2011. 64, 328-335
Scientific Literature Review
Reviewed by: Chuck Hoehn, DPM
Residency Program: University Hospitals Richmond Medical Center / OCPM
Podiatric Relevance:
This study provides useful data for assessing bacterial loads with the use of three different intra-operative irrigation methods during a nail avulsion surgery.
Methods:
This was a prospective randomized study in which 71 patients were enrolled. The three intra-operative antiseptic irrigations used were 0.9% saline solution, 0.2% nitrofurazone and 0.1% polihexanide. Five swab samples were taken from each patient throughout the surgical procedure at distinct stages of each of the procedures. Bacterial culture analyses were then performed on the swabs. 24 patients underwent antiseptic irrigation with 0.9% saline solution, 22 patients underwent antiseptic irrigation with 0.2% nitrofurazone and 25 patients underwent antiseptic irrigation with 0.1% polihexanide.
Results:
Even though all three irrigation methods decreased the bacterial load from the initial swab of each patient, polihexanide was more effective than the other two methods. Polihexanide was also the only method in which there were no post-operative infections. Once the partial nail avulsion was completed and a swab was taken, bacterial counts did return to similar first swab results. Then, by irrigating after the partial nail avulsion with saline, nitrofurazone and polihexanide, it was noted that the bacterial loads were reduced by 95.2%, 96.6% and 99.5% respectively.
Conclusions:
This study shows the importance of an irrigation step when performing a nail avulsion. Furthermore, it shows the efficacy of using polihexanide to reduce the potential for possible post-operative infections.