Evaluation of Surgical Scrub Methods for Large Animal Surgeons

Objective— The objective of this study was to determine the effectiveness of a 5–minute surgical scrub using either a one-brush or a two-brush technique in clean and dirty surgical procedures, and to compare the efficacy of povidone iodine with chlorhexidine as surgical scrub solutions. Study Design— Prospective clinical trial. Methods— Nine veterinarians scrubbed their hands on eight separate occasions using either povidone iodine or chlorhexidine gluconate. A 5-minute scrub and either a one-brush or two-brush technique used in both clean and dirty operations were evaluated by taking glove juice samples before scrubbing, immediately after scrubbing, and 30, 60, 90, and 120 minutes after scrubbing. Glove juice samples were cultured and the colonies were counted. Percent reductions of bacterial forming units were calculated for all eight scrub procedures. Results— All scrub procedures provided an adequate percent reduction in colony forming units (CFU) during the 2–hour sampling period. The number of CFU immediately after scrubbing were significantly lower than prescrub. At 120 minutes, there were significantly fewer CFUs than presecrub, but there were more than immediately after scrubbing. No significant difference in reduction in CFUs were detected between one-brush and two-brush techniques. Both chlorhexidine and povidone iodine scrub solutions adequately reduced bacterial colony counts for 120 minutes after scrubbing regardless of the amount of contamination before skin preparation. Conclusions— Bacterial counts after a hand scrub procedure using a one-brush technique were not significantly different than after a procedure that used a two-brush technique. Povidone iodine and chlorhexidine are equally effectively in decreasing bacterial numbers on the skin, given a variety of contamination levels present before the scrub procedure. Clinical Relevance— Surgeons may use either chlorhexidine or povidone iodine for antiseptic preparation of their hands before surgery. A two-brush technique is not necessary.     

Milrinone

Milrinone, a positive inotropic drug with vasodilating properties, was administered at doses of 0.5 to 1 mg/kg orally twice daily to 29 dogs with moderate to severe congestive heart failure (CHF). Significant echocardiographic improvement in ventricular systolic function was observed after 3 days of administration of milrinone and at the patients' last echocardiographic observation (day 21 in 25 subjects, day 7 in 2 subjects, and day 3 in 2 subjects). Echocardiographic shortening fraction at the initial measurement had a median increase of 6.14% (P less than 0.001), and for the last observation a 2.83% increase (P less than 0.005). Most patients also showed improvement in their clinical signs as assessed by the veterinarian (72%) and by owner's evaluation (81%). No consistent problem or adverse reaction to milrinone was observed, except for a small number of clinically manageable ventricular dysrhythmias. Milrinone appears in this trial to be effective for the treatment of advanced CHF in dogs.     

Surgical Repair of Tibial Tuberosity Avulsion Fractures in Four Horses

Four horses, 2 to 17 years old, were treated for unilateral avulsion fractures of the tibial tuberosity. Two horses were treated successfully with tension band wiring or plating in combination with lag screw fixation. One horse was euthanatized because of implant failure during recovery and one was euthanatized on day 11 because a longitudinal fracture of the tibial tuberosity occurred through the plane of the screws used for stabilization.     

Vascular Response of the Equine Radius to Cerclage Devices

The arterial blood supply to the diaphysis of the radius, and the vascular reaction when three cerclage devices (cerclage wire, Parham-Martin band, and a partially contacting band) were applied 2 cm apart, were studied in six adult ponies. The opposite radial diaphysis served as the control. Ponies were euthanatized at weeks 4 and 8. A centrifugal blood flow pattern was demonstrated by microangiography. Larger numbers of medullary arteries exist in equine than in canine and human long bones. Changes in centrifugal blood supply were not identified beneath any of the cerclage devices.