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Published on: January 6, 2011
Sterile Draping of Operative Microscopes in Breast Free Flaps and Surgical Site Infections
Julian K Marable1, Daisy L Spoer, Varsha Harish1
1From the Georgetown University School of Medicine, Washington, DC.
Background:
Operative microscopes are traditionally draped in single-use plastic to prevent infection theoretically. The necessity of this routine in breast free flap surgery is unclear. Alternatively, sterile wrapping of microscope handles would reduce operating room waste and provide a more cost-effective and environmentally sustainable approach to sterility. This study aimed to determine whether the draping technique used during abdominally based free flaps (Ab-FF) influenced the rate of surgical site infections.
Methods:
We conducted a retrospective review of Ab-FF performed consecutively between March 2017 and August 2022. Patient demographics, comorbidities, perioperative data, and postoperative complications were collected. The primary outcomes included postoperative surgical site infections and environmental impact.
Results:
Of the 281 identified breasts reconstructed with Ab-FF, operating microscopes were sterilely covered with microscope drapes (n = 215) or handle covers (n = 66) composed of polyethylene-based plastic. Overall, postoperative infections occurred in 9.3% of cases (n = 26) in either the recipient breast (n = 11, 3.9%) or abdominal donor site (n = 15, 5.3%), primarily due to S. aureus and Streptococcus species . The handle (n = 6, 9.1%) and drape (n = 20, 9.3%) cohorts had similar infection rates with no sequelae of operative complications. In multivariate analysis, radiation was the only independent predictor of postoperative infection, while bilateral reconstructions were independently protective. Replacing a microscope drape with a handle reduces carbon emissions by 1276 grams of CO 2 and direct costs by $7.84 per item.
Conclusions:
The principles of "Lean and Green" surgery prioritize reducing operating room generated waste to achieve financial and environmental sustainability. This cohort study of 281 breast free flaps demonstrates that switching from whole microscope draping to handle wrapping was not associated with an increased rate or odds of infection. Adopting a microscope handle wrapping protocol decreased the carbon footprint and operative costs. The results of this study offer evidence to support adoption and further exploration of pragmatic, cost-effective, and sustainable approaches to microsurgical breast reconstruction.
Insights
Switching to sterile microscope handle covers in breast free flap surgery significantly reduces waste and costs without increasing infection rates. This sustainable practice aligns with "Lean and Green" surgical principles for better environmental impact.
Area of Science:
- Microsurgery
- Surgical Oncology
- Plastic Surgery
Background:
- Traditional operative microscopes use single-use plastic drapes, raising concerns about infection prevention necessity and waste generation in breast free flap surgery.
- Alternative sterile handle wrapping offers a potentially more cost-effective and environmentally sustainable approach to maintaining sterility.
Purpose of the Study:
- To evaluate the impact of different operative microscope draping techniques (full drapes vs. handle covers) on surgical site infection (SSI) rates in abdominally based free flaps (Ab-FF).
- To assess the environmental and cost implications of switching from traditional microscope drapes to handle covers.
Main Methods:
- Retrospective review of 281 consecutive Ab-FF procedures performed between March 2017 and August 2022.
- Data collected included patient demographics, comorbidities, perioperative details, and postoperative complications, focusing on SSIs at the recipient breast and abdominal donor site.
- Comparison of infection rates and environmental impact (carbon emissions, costs) between microscope drapes and handle covers.
Main Results:
- No significant difference in postoperative infection rates was observed between the microscope drape (9.3%) and handle cover (9.1%) groups.
- Radiation therapy was identified as the sole independent predictor of postoperative infection; bilateral reconstructions were independently protective.
- Replacing microscope drapes with handle covers reduced carbon emissions by 1276 g CO2 and direct costs by $7.84 per item.
Conclusions:
- Switching from whole microscope draping to handle wrapping in Ab-FF surgery is not associated with an increased risk of infection.
- Adopting microscope handle wrapping protocols significantly decreases the carbon footprint and operative costs, supporting "Lean and Green" surgical principles.
- This study provides evidence for the adoption of pragmatic, cost-effective, and sustainable practices in microsurgical breast reconstruction.
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