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Journal of Bone and Joint Surgery - British Volume, Vol 88-B, Issue 3, 382-385.
doi: 10.1302/0301-620X.88B3.17155  
Copyright © 2006 by British Editorial Society of Bone and Joint Surgery
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Should we use a separate knife for the skin?

O. S. Schindler, MD, ÖFD(Orth), FOrth(Ger), FRCS(Orth), Consultant Orthopaedic Surgeon1; R. F. Spencer, MD, FRCS, FCS(SA)Orth, Consultant Orthopaedic Surgeon2; and M. D. Smith, BM, MRCP, FRCPath, Consultant Microbiologist3

1 Droitwich Knee Clinic, St Andrews Road, Droitwich Spa, Worcestershire WR9 8YX, UK.
2 Weston General Hospital, Grange Road, Uphill, Weston-super-Mare BS23 4TQ, UK.
3 Department of Microbiology, Musgrove Park Hospital, Taunton & Somerset NHS Trust, Taunton TA1 5DB, UK.

Correspondence should be sent to Mr O. S. Schindler; e-mail: schindler{at}doctors.net.uk

The aim of this study was to re-assess whether the use of a ‘one-knife technique’ can be considered as safe as the alternative practice of using separate skin and inside knives for elective orthopaedic surgery. A total of 609 knife blades from 203 elective orthopaedic operations, with equal numbers of skin, inside and control blades, were cultured using direct and enrichment media. We found 31 skin blades (15.3%), 22 inside blades (10.8%), and 13 control blades (6.4%) gave bacterial growth.

Of the 31 contaminated skin blades only three (9.7%) had growth of the same organism as found on the corresponding inside blade. It is not known whether contamination of deeper layers in the remaining 90% was prevented by changing the knife after the skin incision. The organisms cultured were predominantly coagulase-negative staphylococci and proprionibacterium species; both are known to be the major culprits in peri-prosthetic infection. Our study suggests that the use of separate skin and inside knives should be maintained as good medical practice, since the cost of a single deep infection in human and financial terms can be considerable.




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Clinical infection rate
Anil Agarwal, et al.
J Bone Joint Surg Br Online, 11 Apr 2006 [Full text]

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Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General