Antibiotic prophylaxis and tourniquet application in podiatric surgery

American College of Foot and Ankle Surgeons’ Clinical Consensus Statement: Perioperative Prophylactic Antibiotic Use in Clean Elective Foot Surgery

“…For surgery involving bone, hardware, or prosthetic joints, the studies specific to foot and ankle surgery did not provide sufficient evidence to change our current clinical consensus (9)(10)(11)(12)(13)(14). Of the 4 included studies relating to use of prophylactic antibiotics and incidence of infection (Table 1), the panel considered 2 studies to be level IV evidence, 1 study to be level III evidence, and 1 study to be level II (Table 3) (17).…”

“…Deacon et al (14) looked at the minimal inhibitory concentration of cefazolin in the bone of the first metatarsal head resected during bunionectomy procedures. They found that administration of 1 g of cefazolin 1 hour prior to tourniquet inflation leads to adequate levels of the drug in bone to inhibit colonization of S. aureus.…”

Clinical Issues‐December 2013

“…Studies are inconclusive about whether the use of a pneumatic tourniquet should influence the timing of prophylactic antibiotics administered 7‐13 . For example, in studies published in 1994 and 1995, researchers examined patients undergoing total knee arthroplasty (TKA) and tibial osteotomies and reported that optimal tissue concentrations were found when antibiotics were administered preoperatively, 20 minutes before tourniquet inflation 7,8 .…”

“…Because a variety of orthopedic procedures other than TKA can be performed with a pneumatic tourniquet, the timing of prophylactic antibiotics for all types of tourniquet‐assisted procedures has not been determined. In a 1996 study, researchers investigated 25 patients undergoing bunionectomy procedures and found that in first metatarsal surgery using ankle tourniquets, a prophylactic antibiotic administered one hour before tourniquet inflation provided adequate levels of antibiotics in the bone 11 . In a 2004 retrospective chart review of 555 patients who underwent elective foot and ankle procedures, researchers concluded that prophylactic intravenous antibiotic use in routine elective foot and ankle surgery is not warranted 12 .…”

Influencia del manguito de isquemia en la profilaxis antibiótica en prótesis total de rodilla

“…La profilaxis antibió-tica pretende mantener altas concentraciones de antibiótico durante toda la intervención para evitar la multiplicación de los gérmenes que contaminan el campo quirúrgico 4,5 . Particularmente, en cirugía ortopédica y traumatología, está establecido que la administración de una dosis de antibió-tico activo frente a la mayor parte de la flora contaminante unos 30 min antes de la intervención, disminuye de forma significativa el riesgo de infección de la herida quirúrgica [6][7][8][9] .…”