Chlorhexidine burns after shoulder arthroscopy

Chlorhexidine is an antiseptic and disinfectant commonly used for surgical site preparation and cleansing. It is active against a broad spectrum of bacteria, viruses, mycobacteria, and fungi. We report 3 cases of patients with superficial partial thickness burns immediately following shoulder arthroscopic surgery with the use of a Chloraprep 26 mL applicator (2% chlorhexidine gluconate and 70% isopropyl alcohol; CareFusion, Leawood, Kansas). All 3 patients reported pain as the anesthetic waned at a localized area on the anterior arm near the axilla. Erythema and blistering were noticeable. These areas were immediately treated with irrigation and local application of ice, and subsequently with topical triple-antibiotic ointment. All 3 cases were resolved within 3 months of surgery, but noticeable scars remained. We believe a combination of chlorhexidine skin preparation, local swelling inherent to shoulder arthroscopy, and traction contributed to these postoperative complications.