Antibiotic prophylaxis and tourniquet application in podiatric surgery

The use of prophylactic antibiosis in podiatric surgery is common, especially in patients undergoing endoprosthetic procedures, major arthrodeses, lengthy procedures, or in immunocompromised patients. The goal of prophylaxis is to prevent infection. For this to occur, there must be an adequate concentration of the antimicrobial agent in the tissue at the time of the incision. Historically, prophylaxis has consisted of intravenous administration of 1 gm. of cefazolin, 30 to 60 minutes prior to surgery. Cefazolin concentrations in the medial eminence of the first metatarsal were measured in patients undergoing bunionectomy procedures where pneumatic ankle tourniquets were used for hemostasis. The goal of this study was to determine if the current standards of prophylactic antibiotic administration provide adequate bone levels of cefazolin to effectively inhibit potential infection-causing pathogens.