Abstract
small opening in a sterile drape; previously described as the “no touch” technique. METHODS: 2510 consecutive patients underwent insertion of an IPP by a single surgeon over a ten year period. 120 patients that had removal and replacement of their prosthesis were considered the “standard group.” This group received anti-infective measures that included: pre-surgical self-cleansing with chlorhexidine soap; prophylactic antibiotics consisting of a flouroquinolone for three days perioperatively; vancomycin and gentamicin given within two hours of incision; a surgical scrub with chlorhexidine soap followed by chloraprepTM application; and standard intra-operative sterile technique. 283 patients underwent removal and replacement with the same preoperative measures but the intra-operative technique was supplanted by the “no touch” technique: a 3MTM 1012 drape is employed after the skin incision to isolate the operative field from the surrounding skin. All of the surgical instruments and gloves that come in contact with the skin are discarded prior to placement of this drape. The entire procedure is performed through a small opening in this drape. Saline irrigation was used in both groups to wash out all implant spaces. RESULTS: Four of the 120 patients (3.3%) who underwent removal and replacement with the “standard” technique developed an infection. In the “no touch” group, 1 of the 283 patients (0.35%) developed an infection. The difference was statistically significant at the 5% level (Fisher’s exact test p 0.029). All infections presented within three to six weeks of implantation. CONCLUSIONS: The “no touch” technique for removal and replacement of a malfunctioned IPP is a safe and useful innovation. Performing even difficult removal and replacement IPPs is possible with this technique and allows for complete placement of all components (cylinders, pump and reservoir) to be placed without touching the skin. This greatly reduces the opportunity for infection.
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