Draping Technique Research Articles

Sterile Draping of Operative Microscopes in Breast Free Flaps and Surgical Site Infections.

Operative microscopes are traditionally draped in single-use plastic to prevent infection theoretically. The necessity of this routine in breast free flap surgery is unclear. Alternatively, sterile wrapping of microscope handles would reduce operating room waste and provide a more cost-effective and environmentally sustainable approach to sterility. This study aimed to determine whether the draping technique used during abdominally based free flaps (Ab-FF) influenced the rate of surgical site infections. We conducted a retrospective review of Ab-FF performed consecutively between March 2017 and August 2022. Patient demographics, comorbidities, perioperative data, and postoperative complications were collected. The primary outcomes included postoperative surgical site infections and environmental impact. Of the 281 identified breasts reconstructed with Ab-FF, operating microscopes were sterilely covered with microscope drapes (n = 215) or handle covers (n = 66) composed of polyethylene-based plastic. Overall, postoperative infections occurred in 9.3% of cases (n = 26) in either the recipient breast (n = 11, 3.9%) or abdominal donor site (n = 15, 5.3%), primarily due to S. aureus and Streptococcus species . The handle (n = 6, 9.1%) and drape (n = 20, 9.3%) cohorts had similar infection rates with no sequelae of operative complications. In multivariate analysis, radiation was the only independent predictor of postoperative infection, while bilateral reconstructions were independently protective. Replacing a microscope drape with a handle reduces carbon emissions by 1276 grams of CO 2 and direct costs by $7.84 per item. The principles of "Lean and Green" surgery prioritize reducing operating room generated waste to achieve financial and environmental sustainability. This cohort study of 281 breast free flaps demonstrates that switching from whole microscope draping to handle wrapping was not associated with an increased rate or odds of infection. Adopting a microscope handle wrapping protocol decreased the carbon footprint and operative costs. The results of this study offer evidence to support adoption and further exploration of pragmatic, cost-effective, and sustainable approaches to microsurgical breast reconstruction.

A Sustainable Solution for Reducing Draping Waste in Cleft Surgeries.

This study aims to reduce the waste generated from primary cleft lip and/or palate (CL/P) repair. A retrospective chart review examined a single surgeon's experience with CL/P repair using standard draping technique and reduced draping technique. Fisher's exact tests were performed comparing complication rates between techniques. All procedures were conducted at a single academic medical center under the care of a board-certified pediatric plastic surgeon and fellowship-trained pediatric anesthesiologists. The study included all patients ≤ 24 months of age who underwent primary CL/P repair using a reduced draping technique at the senior author's institution. An equivalent number of patients who underwent CL/P repair by the senior author immediately prior to implementation of the reduced draping technique were included for comparison. Patients undergoing CL/P repair before the change in technique were draped using the standard CL/P draping. The senior author then switched to using a reduced draping on all CL/P repairs afterwards. Weights and costs of both draping sets were obtained and differences calculated. A manual chart review was performed to assess rates of accidental intraoperative extubation, postoperative infection, fistula formation, and wound dehiscence. The implementation of a reduced draping technique resulted in a 530 gram weight savings and $7.49 cost savings per procedure. Fisher's exact tests revealed no statistically significant differences in complication rates except for oral mucosal dehiscence, which was lower in the reduced draping group. Reduced draping in CL/P repairs significantly reduces operative waste without compromising surgical outcomes.

Intraoperative cell salvage technique in patients undergoing complex endovascular aortic repair

Complex endovascular aortic repair (EVAR) requires the use of multiple small sheath cannulation inside a large sheath. Because the large sheath is not designed for multiple small sheath cannulation, large amounts of blood loss can be encountered in complex EVARs. Cell Saver can be used effectively in complex EVARs using a modified draping technique, allowing for increased cell salvage and autogenous transfusions as needed.

Consensus-based ethical best practices for performing educational point-of-care ultrasonography in the emergency department.

There is no standardized protocol for performing educational point-of-care ultrasonography (POCUS) that addresses patient-centered ethical issues such as obtaining informed consent. This study sought to define principles for ethical application of educational POCUS and develop consensus-based best practice guidance. A questionnaire was developed by a trained ethicist after literature review with the help of a medical librarian. A diverse panel including experts in medical education, law, and bioethics; medical trainees; and individuals with no medical background was convened. The panel voted on their level of agreement with ethical principles and degree of appropriateness of behaviors in three rounds of a modified Delphi process. A high level of agreement was defined as 80% or greater consensus. Panelists voted on 38 total items: 15 related to the patient consent and selection process, eight related to practices while performing educational POCUS, and 15 scenarios involving POCUS application. A high level of agreement was achieved for 13 items related to patient consent and selection, eight items related to performance practices, and 10 scenarios of POCUS application. Based on expert consensus, ethical best practices include obtaining informed consent before performing educational POCUS, allowing patients to decline educational POCUS, informing patients the examination is not intended to be a part of their medical evaluation and is not billed, using appropriate draping techniques, maintaining a professional environment, and disclosing incidental findings in coordination with the primary team caring for the patient. These practices could be implemented at institutions to encourage ethical use of educational POCUS when training physicians, fellows, residents, and medical students.

Tri-zone aseptic draping technique for temporomandibular joint surgery: a technical note

Tri-zone aseptic draping technique for temporomandibular joint surgery: a technical note

The Use of Iodophor-Impregnated Drapes in Patients With Iodine-Related Allergies: A Case Series and Review of the Literature.

The use of iodophor-impregnated adhesive drapes have become almost universally incorporated into standard practice of arthroplasty draping technique. Iodine-related allergies in patients planned for joint replacement present a challenge in terms of the best course of action to minimize complications and optimize outcomes. This is a retrospective case series of patients that received an iodophor-impregnated drape as part of draping for a total hip or knee arthroplasty at a single orthopaedic-specific hospital with documented iodine-related allergies. From 2015 to 2023, 9816 total hip arthroplasty and total knee arthroplasty cases were reviewed, and 135 were documented to have an iodine-related allergy for a prevalence of 1.38%. Intraoperative and postoperative records were reviewed to screen for an allergic reaction or wound healing issues that may have been related to an adverse reaction to the use of the iodophor-impregnated drape. Of the 135 patients, 43 had iodine listed as an allergy, 85 had shellfish, 20 had iodinated contrast media, and 3 had povidone iodine. Sixteen patients had a cluster of iodine-related allergies. There were no intraoperative reports of an allergic reaction to this drape. There were four superficial wound problems, none of which were documented to relate to an allergic dermatitis reaction, and none required further surgery. Patients reporting iodine-related allergies were present in 1.38% of patients undergoing hip or knee arthroplasty in our series. We encountered no allergic reactions or adverse outcomes that could be attributed to the use of iodiphor impregnated drapes in these patients.

Per-operative COVID-19 modifications for oculoplastic service: patients perspective and regional review of practice of a protective draping technique.

COVID-19 has posed problems for oculoplastic surgeons. One issue we felt needed to be addressed was the way patients are draped for surgery. Traditionally patients are draped with their full face exposed, and as a result, aerosols generated from both the patient and surgical team put the other party at risk. We created a new draping technique which would create a physical barrier. A regional survey was undertaken to compare regional oculoplastic draping practices with our practice locally in light of the COVID-19 pandemic. A patient satisfaction survey was also completed to understand the impact of our change in practice. Our regional survey generated 22 consultant responses. 36% (8) continued with their normal practice with the full face exposed. 18% (4) of the responders had modified a cataract drape and 45% (10) used a bespoke drape with or without a mask. We started using this modified drape in June 2020 and in the patient survey, 100 percent of patients felt the drape was comfortable and 30% of the patients commented on the relief that they did not have to wear a face mask during surgery. Our draping technique provides an alternative to the traditional full face exposure draping. It is simple, inexpensive, and readily available. It also addresses and resolves the issue of safety of the oculoplastic surgeon and surgical team whilst maintaining comfort for the patient throughout, particularly when risks the of COVID are ongoing and with the potential of more viruses in the future.

A Unique Urine Isolating Drape Technique for on Table Pyeloscopy Post Radical Cystectomy for a Suspected Upper Tract Lesion With an Obliterated Ureteric Orifice

A 72-year old male undergoes a transurethral resection of a 1.5 cm bladder tumor occluding the left ureteric orifice which was found to be a high grade pT2 urothelial carcinoma with an obliterated left ureteric orifice. In the workup before the procedure a CT intravenous pyelogram revealed a filling defect in the left lower pole and renal calyx. An MRI scan did not demonstrate any filling defects. Here are the CT and MRI scans below.

Block pattern design system using 3D zoning method on digital environment for fitted garment

The 2D pattern-making methods which are entirely based on body measurements are widely used and practiced to design garments in today’s digital environment. Such a method is highly criticized due to a lack of consideration for the body's different morphological and anthropometric data. However, such a method would be effective with many precise and repetitive adjustments and with the help of manual expert know-how. For the last few decades, designers have also used a garment designing technique that is carried out directly on a physical mannequin or fashion model, called the draping technique. The current study is devising and implementing a digital garment design technique in the 3D pattern-making process to create and fit the human body morphology in a 3D digital environment. This technique is based on the analysis of 2D pattern-making methods used by model makers. It also highlights the morphological contour and anthropometric links that have been used to develop a similar method in a 3D environment. However, the proposed methods are performed directly on the 3D wearer's morphology as in the manual 3D draping techniques, which avoids morphological interpretation errors. Such a process helps to control the fit of the 3D garment by determining the ease allowance. Besides, the methods integrated a 3D zoning technique to improve the 3D modelling and to ensure the best possible drape and analysis between the garment and the wearer's body. Further work is required to validate the block pattern for general application based on various parameters including fabric, garment style, body position, etc.

Videourology Abstracts

Journal of EndourologyVol. 36, No. 6 AbstractsFree AccessVideourology AbstractsPublished Online:7 Jun 2022https://doi.org/10.1089/end.2022.29124.vidAboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail A Unique Urine Isolating Drape Technique for On-Table Pyeloscopy to Exclude Suspected Upper Tract Urothelial Carcinoma During Radical CystectomyZein Alhamdani, MD,1 Sean Ong, MBBS,2 Nathan Lawrentschuk, MBBS PhD FRACS (Urology),3 and Dixon Woon, MBBS (Hons), DMedSc, FRACS (Urology)11Department of Surgery, University of Melbourne, Austin Health, Heidelberg, Australia.2Department of Surgery, University of Melbourne, Parkville, Australia.3Department of Urology, The Royal Melbourne Hospital, University of Melbourne, Parkville, Australia.Clinical History: A 72-year-old man undergoes a transurethral resection of a 1.5 cm bladder tumor completely obliterating the left ureteral orifice (UO). A radical cystectomy was performed as the tumor was found to be a high-grade pT2 urothelial carcinoma. A computed-tomography intravenous pyelogram phase clearly demonstrated a filling defect in the left lower pole and renal calix; however, an magnetic resonance imaging postcontrast failed to detect the same filling defects, possibly secondary to inadequate filling as the obstruction progressed.Physical Examination: Physical examination was unremarkable and vital signs were within normal parameters.Diagnosis: The history raises high clinical suspicion for an upper tract urothelial carcinoma. At a multidisciplinary team meeting, some surgeons advocated for a radical nephroureterectomy, others a unique drape technique that facilitates on-table pyeloscopy.Intervention: To investigate the upper tract filling defect, retrograde pyeloscopy was not possible because of the obliterated left UO. Our novel technique is the first described to facilitate on-table pyeloscopy with an open ureter that diverts ureteral fluid into a pouch instead of the abdomen after radical cystectomy when upper tract access is not otherwise possible. The diversion of ureteral fluid from the abdominal cavity minimizes the catastrophic theoretical risk of tumor seeding1–5 that has been known to happen along percutaneous nephrostomy tracts.6Follow-up/Outcomes: The filling defect was most likely caused by a fungal ball seen on pyeloscopy, and as there were no signs of malignancy observed this patient was saved from a potential nephroureterectomy.Patient consent statement: “I give full informed consent to the research team for this research project including recording of the operation for the purposes of research and publication of a video and any written materials.”http://online.liebertpub.com/doi/full/10.1089/vid.2022.0018

Innovations in otorhinolaryngology in the age of COVID-19: a systematic literature review.

ObjectiveOtolaryngologists are at increased occupational risk of Coronavirus Disease 2019 (COVID‐19) infection due to exposure from respiratory droplets and aerosols generated during otologic, nasal, and oropharyngeal examinations and procedures. There have been a variety of guidelines and precautions developed to help mitigate this risk. While many reviews have focused on the personal protective equipment (PPE) and preparation guidelines for surgery in the COVID‐19 era, none have focused on the more creative and unusual solutions designed to limit viral transmission. This review aims to fill that need.Data SourcesPubMed, Ovid/Medline, and ScopusMethodsA comprehensive review of literature was performed on September 28, 2020 using PubMed, Ovid/Medline, and Scopus databases. All English‐language studies were included if they proposed or assessed novel interventions developed for Otolaryngology practice during the COVID‐19 pandemic. The Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines were followed.ResultsA total of 41 papers met inclusion criteria and were organized into 5 categories (‘General Recommendations for Otolaryngologic Surgery’, ‘Equipment Shortage Solutions’, ‘Airway Procedures’, ‘Nasal Endoscopy and Skull Base Procedures’, and ‘Otologic Procedures’). Articles were summarized, highlighting the innovations created and evaluated during the COVID‐19 pandemic. Creative solutions such as application of topical viricidal agents, make‐shift mask filters, three‐dimensional (3‐D) printable adapters for headlights, aerosol containing separation boxes, and a variety of new draping techniques have been developed to limit the risk of COVID‐19 transmission.ConclusionsPersistent risk of COVID‐19 exposure remains high. Thus, there is an increased need for solutions that mitigate the risk of viral transmission during office procedures and surgeries, especially given that most COVID‐19 positive patients present asymptomatically. This review examines and organizes creative solutions that have been proposed and utilized in the otolaryngology. These solutions have a potential to minimize the risk of viral transmission in the current clinical environment and to create safer outpatient and operating room conditions for patients and healthcare staff.

A Unique Urine Isolating Drape Technique for On-Table Pyeloscopy to Exclude Suspected Upper Tract Urothelial Carcinoma During Radical Cystectomy

A Unique Urine Isolating Drape Technique for On-Table Pyeloscopy to Exclude Suspected Upper Tract Urothelial Carcinoma During Radical Cystectomy

C-arm contamination of the surgical field: Can contamination be reduced with an intervening drape?

IntroductionContamination of the surgical field by the C-arm in orthopaedic procedures is a significant potential source for surgical site infections. The purpose of this study was to explore the utility of a split sheet to aid in prevention of secondary contamination from the C-arm on the C-arm side of the operative field. MethodsA C-arm and a surgical table were draped by standard techniques. The surgical table was split in thirds: the surgeon's side, the C-arm side of the operative field, and the middle for contamination analysis. Fluorescent powder was used to simulate a contaminant and placed on the C-arm, floor and lower portions of drapes. The C-arm was cycled between PA and Lateral positions. Powder transfer to the field was visualized with a camera under uniform UV light. Photographs were taken to measure fluorescent pixels prior to cycling the C-arm and at 5, 10 and 15 cycles. This protocol was repeated using a split sheet (U-drape) to isolate the C-arm below the operative field. Image J was utilized to calculate differences in the number of pixels brighter than the control image. ResultsUsing standard draping techniques, there was contamination of the surgical field with the C-arm side of the operative field having the highest level of fluorescent pixels. The number of fluorescent pixels was linearly correlated with the number of PA to Lateral cycles. At the end of 15 cycles, the average number of fluorescent pixels for the intervening draping technique was 2.9 pixels compared to the standard draping technique of 3939 pixels (p = 0.0078). DiscussionThe addition of a U-drape between the C-arm and the table results in a statistically significant reduction in surgical field contamination as a result of secondary transfer from the C-arm. Level of evidenceII

Enhanced Draping for Oculoplastic Surgery to Minimize Respiratory Exposure During the COVID-19 Pandemic

Surgeons and surgical staff operating on the face are at risk of respiratory-based infectious transmission given their proximity to the patient’s nose and mouth in the surgical field. We describe a modified sterile draping technique that creates a midface seal with inferior ventilation that minimizes surgeon and staff exposure to patient respiratory emissions and potential transmission of infectious diseases, as well as mitigates fire risk during oculoplastic surgery and other surgeries involving the upper face.

Surgical site infection-inflammation in dogs draped with a single-layer Kraton elastic seal extremity drape for stifle surgery.

To compare the incidence of surgical site infection-inflammation in dogs undergoing elective orthopedic surgery of the stifle after draping with a single-layer Kraton elastic seal patient drape or conventional double-layer drapes. Prospective clinical trial. A total of 789 dogs. Dogs were assigned to one of two groups: (1) conventional draping with 4-corner drapes and an overlying patient drape (n=390) or (2) a Kraton seal extremity patient drape without 4-corner drapes (n=399). All dogs were evaluated for surgical site infection-inflammation by 21 days and 6months postoperatively. The distribution of surgical procedures did not differ between draping techniques and included tibial tuberosity advancement (TTA, n=480), tibial plateau leveling osteotomy (TPLO, n=10), extracapsular lateral suture (ECLS, n=130), medial patellar luxation repair (MPL, n=63), lateral patellar luxation repair (LPL, n=1), ECLS/MPL (n=68), TTA/MPL (n=12), TTA with joint capsule biopsy (n=1), and stifle arthroscopy combined with TTA or TPLO (n=24). Duration of follow up was 180 days (range 3-180 days) for clinical examinations and 182 days (range 2-182 days) for phone communications. Infection-inflammation was documented in 9 dogs after double-layer draping and 11 dogs after single-layer draping at 21 days postoperatively and in 12 dogs after double-layer draping and 7 dogs after single-layer draping at 6 months postoperatively. No difference in postoperative infection-inflammation was detected between canine stifle surgeries draped with a single-layer Kraton extremity patient drape or double-layer drapes. The single-layer Kraton extremity patient drape is a viable alternative to conventional double-layer draping in canine stifle surgery.

Otitis Media Practice During the COVID-19 Pandemic

The global coronavirus disease-2019 (COVID-19) pandemic has changed the prevalence and management of many pediatric infectious diseases, including acute otitis media (AOM). Coronaviruses are a group of RNA viruses that cause respiratory tract infections in humans. Before the COVID-19 pandemic, coronavirus serotypes OC43, 229E, HKU1, and NL63 were infrequently detected in middle ear fluid (MEF) specimens and nasopharyngeal aspirates in children with AOM during the 1990s and 2000s and were associated with a mild course of the disease. At times when CoV was detected in OM cases, the overall viral load was relatively low. The new severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is the causative pathogen responsible for the eruption of the COVID-19 global pandemic. Following the pandemic declaration in many countries and by the World Health Organization in March 2020, preventive proactive measures were imposed to limit COVID-19. These included social distancing; lockdowns; closure of workplaces; kindergartens and schools; increased hygiene; use of antiseptics and alcohol-based gels; frequent temperature measurements and wearing masks. These measures were not the only ones taken, as hospitals and clinics tried to minimize treating non-urgent medical referrals such as OM, and elective surgical procedures were canceled, such as ventilating tube insertion (VTI). These changes and regulations altered the way OM is practiced during the COVID-19 pandemic. Advents in technology allowed a vast use of telemedicine technologies for OM, however, the accuracy of AOM diagnosis in those encounters was in doubt, and antibiotic prescription rates were still reported to be high. There was an overall decrease in AOM episodes and admissions rates and with high spontaneous resolution rates of MEF in children, and a reduction in VTI surgeries. Despite an initial fear regarding viral shedding during myringotomy, the procedure was shown to be safe. Special draping techniques for otologic surgery were suggested. Other aspects of OM practice included the presentation of adult patients with AOM who tested positive for SARS-2-CoV and its detection in MEF samples in living patients and in the mucosa of the middle ear and mastoid in post-mortem specimens.

Double occlusive adhesive draping technique for shoulder arthroplasty

Double occlusive adhesive draping technique for shoulder arthroplasty

Developments of Adapted Clothing for Physically Disabled People with Scoliosis Using 3D Geometrical Model

Scoliosis is a deformity of the spine that causes disorders of the rib cage. This makes it difficult to design clothes for affected people without following the shape of the rib cage. This paper presents a new 3D clothing design method based on virtual reality for women with physical disabilities such as scoliosis. The current design method is a variation of the draping techniques commonly used by fashion designers to design clothes on a mannequin or human body. However, the current design process highly considers the skeleton and body scan of the person. The skeleton is used to detect the anthropometric points of the patient, while the body scan allows us to detect the morphological contours at the onset of scoliosis. Thus, both allow us to accurately track the patient’s morphology and atypical shape. The position of the morphological contours is indicated by reference marks that are closely associated with the skeleton. This helps to automatically adapt the garment to the evolution of the patient’s pathology over time. The process of creating the 3D garment was processed based on the 3D model of the thorax, which helps to easily determine the anthropometric points and the morphological curves. Using this data, the geometrical model of the garment could be created with 3D ease allowances. The 2D block pattern was then obtained by flattening the 3D patterns using flattening methods. Finally, various tests were performed considering the evolution of pathology to predict the future garment. These tests validate our geometrical model of the garment with 3D ease allowances by comparing the results with previous work.

Evaluation of a novel C-Arm draping technique to minimize surgical field contamination and surgery time.

The purpose of this study is to compare the sterility of three C-Arm draping techniques: the clip-drape, sterile pouch, and a novel drape tower method. We hypothesize that our novel technique will minimize floor contamination from reaching the surgical field while allowing the C-Arm machine to rotate between lateral and anterior-posterior positions more quickly. Five trials consisting of rotating the C-Arm and simulating surgeon movement were run using each technique. Ultraviolet light illuminating melamine powder was used to represent floor contamination. Measurements of melamine powder encroachment on the drapes were taken using the top of the C-Arm in lateral position as the reference point. The time needed to assemble, deploy, and retract the C-Arm was measured for each technique. The gown, gloves, and mayo stand were also examined after each trial for contamination. Compared to the clip drape, the drape tower prevented contamination from reaching the C-Arm by an additional 30.5cm (95% confidence interval (CI): 17.0-43.9, P < 0.001). The drape tower had faster deployment and retraction times than both the clip drape (P < 0.001 and P < 0.001, respectively) and sterile pouch (P=0.011 and P < 0.001, respectively). The clip drape and sterile pouch exhibited glove contamination in two (40%) simulations, while the drape tower showed no instances of contamination (P=0.255). The novel drape tower technique limits the encroachment of floor contamination onto sterile drapes. It should be considered as an alternative draping method for lower extremity surgery.

Comparison of 3 C-Arm Draping Techniques to Prevent Far Side Contamination.

To assess the effectiveness of reducing contamination using 2 methods of C-Arm draping compared with traditional methods. The authors simulated an operating room using an extremity drape, commercially available C-Arm drapes, and C-Arm. A black light was placed above the field. A fluorescent powder was placed on the nonsterile portions of the field. Baseline light intensity was recorded by photo. The C-Arm was brought into the surgical field for orthogonal imaging for 15 cycles. A repeat photograph was taken to measure the increase in intensity of the fluorescent powder to assess degree of contamination. This was repeated 5 times for each configuration: standard C-Arm drape, a proprietary close-fitting drape, and a split drape secured to the far side with the split wrapped around the C-Arm receiver. Light intensity difference was measured and average change in intensity was compared. Compared with standard draping, the proprietary close-fitting drape resulted in a 71.3% decrease in contamination (4.84% vs. 16.90%, P = 0.101) that trended toward significance and the split drape resulted in a 99.5% decrease (0.09% vs. 16.90%, P = 0.017) that was statistically significant. Far side contamination can be reduced by using a split drape connecting the operative table to the C-Arm receiver, effectively "sealing off" contaminants. The proprietary close-fitting drape may also decrease contamination, but this was not statistically significant in this study. Use of the split drape technique will help prevent contamination and may ultimately lead to decreased infection risk.