One scalpel for major surgical procedures

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Recently, the question of whether the scalpel blade used to make the skin incision must be discarded because of the fear of contaminating. deeper tissues with skin bacteria has been reexamined. Traditionally, once the epidermal and dermal skin layers are incised, the knife blade should be changed so that skin organisms will not be implanted into the subcutaneous tissue, proliferate, and lead to the development of wound infections.

The validity of this belief was tested by doing a bacterial and clinical study of patients undergoing operations when only one knife was used.

Materials and methods

Fifty consecutive patients who underwent operations on one general surgical service (A.M.C.) between March 15, 1974 and May 1, 1974, were included in the study. For all patients the operative site was shaved the evening prior to surgery, and a 5-minute skin preparation with an iodophor (Betadine) was used after induction of anesthesia. Two sterile knife blades were then removed from their packages, and one was cultured by placing it in liquid thioglycolate medium (control). The second blade was used for the incision and discarded only when all layers of skin and subcutaneous tissue were entered or the blade became dull. It was then cultured in liquid thioglycolate medium.

At the completion of the operation a culture of the wound was taken and the wound was closed. Nylon skin sutures, not subcutaneous sutures, were used. The wound was then examined daily.


A summary of operative procedures, control and scalpel cultures, wound cultures, and clinical. . .



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