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Effect of Preoperative Chlorhexidine Gluconate Cleanse on the Rate of Lower Extremity Surgical Site Infections
abstract
This abstract is available on the publisher's site.
Access this abstract nowBACKGROUND
Lower extremity surgical sites are at an increased risk of wound infection following Mohs micrographic surgery.
OBJECTIVE
To evaluate the rate of lower extremity surgical site infections following a 14-day regimen of preoperative 4% chlorhexidine gluconate (CHG) rinses and postoperative wound occlusion for 14 days.
MATERIALS AND METHODS
Retrospective data were collected from procedures performed by the senior author from January 2022 through June 2023. To meet inclusion, patients must have completed waist-down CHG soak and rinse for 14 days before surgery, including the day before surgery. In addition, the patient must have kept the dressing clean, dry, and intact until the postoperative appointment at 14 days.
RESULTS
A total of 100 Mohs cases met inclusion criteria. Zero patients developed a surgical site infection.
CONCLUSION
Chlorhexidine gluconate preoperative rinsing and postoperative occlusion for 14 days may minimize the risk of wound infection. Although further research is indicated, an opportunity exists for the adoption of CHG into routine clinical practice in the outpatient dermatology setting.
Additional Info
Disclosure statements are available on the authors' profiles:
The Effect of Preoperative Chlorhexidine Gluconate Cleanse on Lower Extremity Surgical Site Infections: A Retrospective Cohort Study
Dermatol Surg 2024 Mar 22;[EPub Ahead of Print], MP Dempsey, AM Riopelle, M West, A Kumar, CF SchanbacherFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
We commend the authors on this well-designed and impressive demonstration of the efficacy of preoperative chlorhexidine gluconate use in the prevention of lower-extremity wound infections following Mohs micrographic surgery. A brief review of the literature reveals the broad range of surgical specialties, including obstetrics,1 orthopedics,2 and neurosurgery3 to name a few, reporting the benefits of this antiseptic. However, despite these convincing results, it is crucial to consider the outpatient setting in which dermatologic surgery is performed and the relative scarcity of studies exploring the utility of preoperative antiseptics in this unique context.
Prior meta-analyses4 and cohort studies5 within the dermatologic surgery literature have convincingly shown the elevated risk of infection that comes with lower-extremity surgical sites, secondary intention healing, and the outpatient setting overall. Recent work published in the April issue of Dermatologic Surgery6 shows that, while Staphylococcus aureus is the most common culprit organism for infections of wounds healing by second intention on the lower extremities, nearly one-third of wounds were found to be clinically infected despite culture results showing "normal skin flora.” This may suggest a polymicrobial etiology at times and underscores the importance of utilizing a broad-spectrum antiseptic such as chlorhexidine. Surgeon preferences regarding preoperative cleansing are undoubtedly variable; however, it is vital to consider our own subspecialty literature when making these decisions. We look forward to future prospective studies that shed light on additional antiseptic protocols that build upon the excellent work of Dempsey and colleagues.
References