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Do Skin Tears with Arthroscopic Knot Tying Represent a Contamination Risk?
Matthew B Burn, MD; Heidi Holtorf, MD; Kevin M Smith, MD; Derek T Bernstein, MD; Nickarr Prudhomme, MA; Michael Deavers, MD; Patrick C McCulloch, MD; Joshua D Harris, MD
Houston Methodist Hospital, Houston, TX

Introduction: It is estimated that the rate of glove perforation in clinical arthroscopic procedures is between 26-57%, but the risk of cross-contamination due to these tears is unknown. This study's purpose was to quantify the number of epithelial cells found on arthroscopic suture following arthroscopic knot tying and to see if this correlates with the presence of glove tears and/or number of knots thrown between glove changes.
Materials & Methods: Using a standardized technique, knots were tied arthroscopically by two orthopaedic surgeons using #2 UltraBraid suture (Smith & Nephew, London, UK). Gloves (both inner and outer) were changed and collected after tying knots for two sutures, four sutures, or six sutures. Both sets of gloves were tested for perforation (1) using an electroconductivity meter in a saline bath, and (2) using a saline load test. Sutures were collected after each suture was tied and placed into sterile ThinPrep CytoLyt solution vials for cytopathologist analysis, where the number of epithelial cells in 10 high-powered fields (hpf) was counted. Positive and negative suture control samples were created. Descriptive statistics were calculated.
Results: All inner (12) and outer (12) gloves were analysed for perforations. Only one glove tear was present after tying one 6-suture set giving a perforation rate of (1) 4.2% overall and (2) 8.3% for outer gloves. The number of epithelial cells found in 10 hpf for the: (1) positive control was 244 cells (SD 18, Range 231-257), (2) negative control #1 (i.e. empty containers) was 1 cell (SD 0, Range 1-1), and (3) negative control #2 (i.e. untouched sutures) was 10 cells (SD 5, Range 5-15). Test sample epithelial cells in 10 hpf by the number knots tied were: (1) 2 cells (SD 2, Range 0-5), (2) 1 cell (SD 0, Range 1-1), (3) 1 cell (SD 1, Range 0-3), (4) 1 cell (SD 0, Range 1-1), (5) 4 cells (SD 4, Range 1-7), and (6) 1 (SD 0, Range 1-1), respectively.
Conclusion: No prior studies have quantified the number of epithelial cells found on suture after arthroscopic knot tying. Although epithelial cells were identified on suture in every sample, the number did not differ from those found in the negative controls and there were no simultaneous inner/outer glove perforations. This implies that the laceration represents an indirect friction injury or pressure necrosis, rather than actual contact between the suture material and the surgeons' skin.


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