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INTRODUCTION The aim of this study was to investigate the degree of contamination of a surgeon's hand following use of chlorhexidine gluconate or alcohol gel as disinfectants. MATERIALS AND METHODS In this prospective, randomised trial, orthopaedic surgeons were allocated to one of two different hand-washing protocols using a randomisation table. The hand-washing protocol dictated that all surgeons should wash for 5 min with chlorhexidine for their first case. Thereafter, the surgeon was randomised to wash for 3 min with either alcohol gel or chlorhexidine. At the end of each procedure, the gloves of each surgeon were carefully removed and the fingertips from each hand were placed on an agar plate. The number of bacterial colonies present after 24 h and 48 h of incubation were recorded for each agar plate by a microbiologist blinded to the washing protocol used. RESULTS Overall, 41 procedures and 82 episodes of hand washings were included in the study. Two episodes were discarded due to contamination at the time of glove removal. Four hands (8%) were contaminated in the chlorhexidine group compared to 19 (34%) in the alcohol group. Fisher's exact test confirmed a significantly higher risk of contamination using alcohol gel compared to chlorhexidine (P = 0.002). In addition, the average bacterial colony count was substantially higher in the alcohol group (20 colony forming units) compared to the chlorhexidine group (5 colony forming units). There was no relationship between the duration of surgery and the degree of contamination (P = 1.12). CONCLUSIONS Alcohol gel disinfectant is not a suitable alternative to chlorhexidine when hand washing before surgery. This study has identified a higher risk of bacterial contamination of surgeons' hands washed with alcohol. This may lead to higher levels of postoperative infection in the event of glove perforation.

We carried out lacerations of 50%, followed by trimming, in ten turkey flexor tendons in vitro and measured the coefficient of friction at the tendon-pulley interface with loads of 200 g and 400 g and in 10 degrees , 30 degrees, 50 degrees and 70 degrees of flexion. Laceration increased the coefficient of friction from 0.12 for the intact tendon to 0.3 at both the test loads. Trimming the laceration reduced the coefficient of friction to 0.2. An exponential increase in the gliding resistance was found at 50 degrees and 70 degrees of flexion (p = 0.02 and p = 0.003, respectively) following trimming compared to that of the intact tendon. We concluded that trimming partially lacerated flexor tendons will reduce the gliding resistance at the tendon-pulley interface, but will lead to fragmentation and triggering of the tendon at higher degrees of flexion and loading. We recommend that higher degrees of flexion be avoided during early post-operative rehabilitation following trimming of a flexor tendon.

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Surgical repair is advocated for partial flexor tendon lacerations deeper than 70%. We compared gliding resistance with three different peripheral repairs in partial flexor tendon lacerations. Thirty flexor tendons and A2 pulleys were harvested from turkey toes. Gliding resistance was measured for all intact tendons. The tendons were then lacerated to 50% and repaired with a modified Kessler core suture and either a Silfverskiold or Halsted repair or a simple running suture and gliding resistance was measured. Compared to the intact tendon, the increase in gliding resistance after surgical repair was 100% with the Halsted repair, 80% with the Silfverskiold repair and 60% with a running suture (p = 0.05). In conclusion, a simple running suture caused less resistance to gliding compared to the other techniques when repairing partial flexor tendon lacerations and we recommend its use when surgical repair is needed.