Reduction in amputation stump infection by antiseptic pre-operative preparation

The prevalence of ischaemic or infective delayed wound healing in amputations for peripheral vascular disease may vary from 18 to 40%. A prospective trial to test the efficacy of 12 h pre-operative preparation with 10% povidone-iodine was performed in a 1-year period, during which time 80 consecutive amputations were performed on 73 patients. Accrual to the treatment arm was incomplete and was principally due to extreme nursing shortages. Failure of randomization resulted in the study being analysed as if it were retrospective. Infection occurred in 14 (23%) of unprepared limbs but was not found in any of the 19 prepared limbs (P less than 0.05). Infection occurred in 11 of 34 unprepared limbs which had distal ulcers or moist gangrenous lesions; however, 15 prepared limbs which had similar distal lesions had no infection (P less than 0.025). The reduction of wound breakdown and infection resulted in a significant reduction in hospitalization prior to commencement of prosthetic fitting (P less than 0.001). Pre-operative antiseptic preparation played an important role in the reduction of infection following amputation for peripheral vascular disease, particularly for those patients whose amputation was required because of contaminated peripheral ischaemic lesions. However, these preliminary results should be confirmed by further study.