Chlorhexidine Gluconate in Limb Preservation Surgery

Introduction: Research of the use of surgical irrigant additives to reduce surgical site infections has been ongoing as surgical site infections can impact quality of outcomes and cost of healthcare. Post-operative infections may increase length of stay, readmission rates, and contribute to further amputations. Many studies have evaluated the use of chlorhexidine gluconate for elective surgical procedures, but there is a lack of literature evaluating its role in foot and ankle infections.Methods:A retrospective chart review individuals undergoing procedures to eradicate foot and ankle infection by a single podiatrist was performed. Individuals were assigned a cohort based on the use of an irrigant with normal saline or chlorhexidine gluconate. Participants were followed for six months to assess for subjective clinical findings such as postoperative erythema and drainage, postoperative dehiscence, and objective outcomes measures like the need for additional surgery, and positive microbiology and pathology findings.Results:58 consecutive individuals were included, 32 underwent irrigation with chlorhexidine gluconate  and 26 with saline. Clinical and demographic data were similar amongst cohorts. Postoperative infection rates as defined by postoperative erythema and drainage were not different. Rates of positive pathology results for osteomyelitis and microbiology results for microbe growth were not different. The type of irrigation and post-operative weight bearing status did effect postoperative dehiscence rates.  Discussion: This is the first study to evaluate the use of chlorhexidine gluconate in surgical interventions for foot and ankle infection. Our study demonstrated chlorhexidine gluconate is an equivalent irrigation technique in comparison to normal saline in terms of postoperative erythema, drainage, positive pathology and microbiology results, and postoperative dehiscence rates. Further studies will be conducted to compare chlorhexidine gluconate to pulse lavage as well as betadine enhanced saline irrigation.References:1. Asadi, K. Int Wound J, 2023 2. Piednoir, E.  Front Public Health, 2021 3. Frisch, N et al, Arthroplasty Today, 2017 4. Rushing CJ, FASTRAC 2023