Background Surgical site infection (SSI) is the most common postoperative complication worldwide. WHO guidelines to prevent SSI recommend alcoholic chlorhexidine skin preparation and fascial closure using triclosan-coated sutures, but called for assessment of both interventions in low-resource settings. This study aimed to test both interventions in low-income and middle-income countries.Methods FALCON was a 2 × 2 factorial, randomised controlled trial stratified by whether surgery was cleancontaminated, or contaminated or dirty, including patients undergoing abdominal surgery with a skin incision of 5 cm or greater. This trial was undertaken in 54 hospitals in seven countries (

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Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries.

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Introduction: Scrotal trauma is a rare surgical emergency that accounts for less than 1% of all traumatic injuries. They are more prevalent in 15-40 years age group. Blunt scrotal trauma contributes to about 80% of all scrotal injuries whilst penetrating scrotal injuries constitute the remaining 20%. Penetrating scrotal injuries are however, more rare in children but can result from bicycle handlebars, falls with impalement, and animal bites. Case Reports: We did a retrospective review of our records over a 7-year period for penetrating scrotal injuries and report two (2) cases involving 13-year old and 14-year old males who sustained injuries from a tree branch and an iron rod respectively after falling from heights. Discussion: Penetrating scrotal trauma can present with complex injury patterns involving the testes and other surrounding structures, and all invariably need urgent scrotal exploration. Consequently, both of our cases had immediate surgical exploration with conservative debridement of non-viable tissue and surprisingly both were spared any testicular injury. Conclusion: Penetrating scrotal trauma may spare the testis and the scrotal contents despite the gravity of the injury.