From the Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA.
J Am Acad Orthop Surg. 2024 Aug 15;32(16):e832-e838. doi: 10.5435/JAAOS-D-23-00703.
Postoperative fracture site infection can lead to notable patient morbidity, increase cost of care, and further contribute to healthcare disparities globally. Dogma suggests surgical blades as a vehicle for introducing bacteria into the surgical site; however, there is a paucity of literature to support this claim. This study uses advanced DNA sequencing to detect bacterial DNA on surgical blades used in upper extremity fracture surgeries.
This was a prospective study, conducted at a high-volume level 1 trauma center. All acute, closed upper extremity fractures requiring surgical stabilization were consecutively enrolled in a prospective fashion. The primary end point was the presence of bacterial DNA on the surgical blade using next-generation sequencing (NGS). At the time of surgery, two blades were sterilely opened. One blade served as the control while the other was used for the initial skin incision. Two negative control blades were opened directly into a sterile container. Two positive control blades were used for skin incision through known infections. All samples were sent for NGS analysis.
Forty patients were enrolled in this study. The median age was 33.5 years, and 30% were female; the median body mass index was 26.52. Humerus fractures were the most common injury (N = 17, 42.5%), followed by clavicle fractures (13, 32.5%) and radius/ulna fractures (10, 25.0%). NGS analysis revealed no contamination of test blades used for skin incision. Three control blades tested positive for bacterial DNA. Negative control blades tested negative for bacterial DNA (0/2); the positive control blades resulted positive for bacterial DNA contamination (2/2).
Surgical blades used for skin incision in the upper extremity are not contaminated with bacterial DNA as analyzed by NGS. This finding challenges previous surgical dogma regarding surgical blade contamination and supports that the same surgical blade can safely be used for deeper dissection.
Level II study: IRB approval-IRB#848938.
术后骨折部位感染可导致患者显著发病，增加医疗费用，并进一步加剧全球医疗保健差距。传统观点认为手术刀片是将细菌带入手术部位的媒介；然而，支持这一说法的文献却很少。本研究使用先进的 DNA 测序技术检测上肢骨折手术中使用的手术刀片上的细菌 DNA。
这是一项前瞻性研究，在一家高容量的 1 级创伤中心进行。所有需要手术固定的急性闭合性上肢骨折均连续进行前瞻性入组。主要终点是使用下一代测序（NGS）检测手术刀片上是否存在细菌 DNA。手术时，无菌打开两片刀片。一片作为对照，另一片用于初始皮肤切口。直接将两片阴性对照刀片放入无菌容器中。使用两片已知感染的阳性对照刀片进行皮肤切开。所有样本均进行 NGS 分析。
本研究共纳入 40 例患者。患者的中位年龄为 33.5 岁，30%为女性；中位 BMI 为 26.52。肱骨骨折最常见（17 例，42.5%），其次是锁骨骨折（13 例，32.5%）和桡骨/尺骨骨折（10 例，25.0%）。NGS 分析显示，用于皮肤切开的测试刀片未受到污染。3 片对照刀片检测出细菌 DNA 阳性。阴性对照刀片检测出细菌 DNA 阴性（0/2）；阳性对照刀片检测出细菌 DNA 污染阳性（2/2）。
通过 NGS 分析，用于上肢皮肤切开的手术刀片未被细菌 DNA 污染。这一发现挑战了之前关于手术刀片污染的传统观点，并支持同一片手术刀片可安全用于深部解剖。
II 级研究：IRB 批准-IRB#848938。
