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Quantification of Strain in a Porcine Model of Skin Expansion Using Multi-View Stereo and Isogeometric Kinematics
Published on: April 16, 2017
A Porcine Model for the Development and Testing of Preoperative Skin Preparations
Hannah R Duffy1,2, Rose W Godfrey1, Dustin L Williams1,2,3,4
1Department of Orthopaedics, University of Utah, Salt Lake City, UT 84112, USA.
Abstract:
Clinical preoperative skin preparations (PSPs) do not eradicate skin flora dwelling in the deepest dermal regions. Survivors constitute a persistent infection risk. In search of solutions, we created a porcine model intended for PSP developmental testing. This model employed microbiological techniques sensitive to the deep-dwelling microbial flora as these microorganisms are frequently overlooked when using institutionally-entrenched testing methodologies. Clinical gold-standard PSPs were assessed. Ten Yorkshire pigs were divided into two groups: prepared with either povidone iodine (PVP-I) or chlorhexidine gluconate (CHG) PSP. Bioburdens were calculated on square, 4 cm by 4 cm, full-thickness skin samples homogenized in neutralizing media. Endogenous bioburden of porcine skin (3.3 log10 CFU/cm2) was consistent with natural flora numbers in dry human skin. On-label PSP scrub kits with PVP-I (n = 39) or CHG (n = 40) failed the 2-3 log10-reduction criteria established for PSPs by the Food and Drug Administration (FDA), resulting in a 1.46 log10 and 0.58 log10 reduction, respectively. Porcine dermal microbiota mirrored that of humans, displaying abundant staphylococcal species. Likewise, histological sections showed similarity in hair follicle depths and sebaceous glands (3.2 ± 0.7 mm). These shared characteristics and the considerable fraction of bacteria which survived clinical PSPs make this model useful for developmental work.
Insights
Current skin preparation methods fail to eliminate deep skin bacteria, posing an infection risk. A new porcine model effectively demonstrates that standard povidone iodine (PVP-I) and chlorhexidine gluconate (CHG) skin preparations do not meet FDA reduction criteria.
Area of Science:
- Microbiology
- Dermatology
- Infectious Disease
Background:
- Clinical preoperative skin preparations (PSPs) are essential for reducing surgical site infections.
- Current PSPs do not effectively eliminate skin flora in deeper dermal layers, leaving a persistent infection risk.
Purpose of the Study:
- To develop and validate a porcine skin model for testing the efficacy of preoperative skin preparations (PSPs).
- To assess the effectiveness of standard povidone iodine (PVP-I) and chlorhexidine gluconate (CHG) PSPs against deep-dwelling skin flora using the developed model.
Main Methods:
- A porcine model was established using microbiological techniques sensitive to deep-dwelling skin flora.
- Full-thickness skin samples from Yorkshire pigs treated with PVP-I or CHG were homogenized to calculate bioburden.
- Microbiological and histological analyses were performed to compare porcine skin flora and structure to human skin.
Main Results:
- Porcine skin's endogenous bioburden (3.3 log10 CFU/cm2) resembles dry human skin.
- Both PVP-I (1.46 log10 reduction) and CHG (0.58 log10 reduction) failed to meet the FDA's 2-3 log10 reduction criteria.
- Porcine dermal microbiota and skin structures (hair follicles, sebaceous glands) closely mimic human skin.
Conclusions:
- The developed porcine model is suitable for evaluating PSP efficacy due to its similarity to human skin.
- Standard clinical PSPs, including PVP-I and CHG, are insufficient for eradicating deep skin flora.
- Further research and development of novel PSPs are necessary to address the limitations of current methods.
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