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Background: Reducing intraoperative wound contamination is a critical preventive strategy for reducing the risk of prosthetic joint infection in shoulder arthroplasty. The aim of this study was to investigate the potential microbial colonization of subscapularis tagging sutures during shoulder arthroplasty., Methods: In this prospective study, 50 consecutive patients undergoing primary shoulder arthroplasty (anatomic or reverse) were enrolled. Patients with revision shoulder arthroplasty and proximal humeral fractures were excluded. Nonabsorbable, braided tagging sutures were placed through the subscapularis tendon prior to tenotomy. A similar nonabsorbable, braided suture (control) was placed in a sterile container on the back table, open to the operating room environment. Subscapularis tagging sutures (experimental specimens) and control sutures were collected prior to subscapularis tenotomy repair and submitted for aerobic and anaerobic cultures. Cultures were held for 21 days to account for extended growth of slow-growing bacteria., Results: A total of 12 of 50 experimental and 16 of 50 control sutures had positive cultures. Staphylococcus epidermidis and Cutibacterium acnes were the 2 most commonly isolated organisms. Active tobacco use (P = .038) and procedure length (P = .03) were significantly associated with positive cultures. No significant association between positive subscapularis tagging suture cultures and positive control cultures was found (P = .551). Patient age, sex, body mass index, and significant medical comorbidities were not significantly associated with positive cultures., Discussion: Subscapularis tagging sutures are a potential source of microbial contaminant in shoulder arthroplasty, and we recommend exchanging the tagging suture with a suture opened immediately prior to subscapularis repair., (Copyright © 2019 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

Background: A major source of microbial colonization of short-term central venous catheters (CVC) is the patients' endogenous skin microorganisms located at the CVC insertion site. The aim of this study was to determine if a transparent film dressing incorporating a 2% (weight/weight) chlorhexidine gluconate (CHG) gel decreases CVC and insertion site microbial colonization compared with a nonantimicrobial dressing in adult patients in critical care., Methods: On CVC removal, samples for microbiological investigation were taken from both the skin surrounding the CVC insertion site and also from sutures securing the CVC. The sutures and intradermal and tip sections of the CVC were also collected for microbiological investigation. Microorganisms recovered from the samples were subsequently tested for susceptibility to CHG., Results: There was a significant reduction in the number of microorganisms recovered from the CVC insertion site, suture site, sutures, and catheter surface in the CHG dressing group (n = 136) compared with the nonantimicrobial dressing group (n = 137). There was no significant difference in susceptibility to CHG between the microorganisms isolated from the CHG and standard dressing study patients., Conclusion: A film dressing incorporating a CHG gel pad significantly reduced the number of microorganisms at the CVC insertion and suture sites with concomitant reduced catheter colonization., (Copyright © 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.)

Background: Stapled hemorrhoidopexy (SH) was conceived and developed in Europe. Over the past decade, there have been reports of severe, life-threatening complications and 2 deaths. These are the first such cases from the Americas including the third known mortality., Methods: Two case reports from US surgeons are combined with eleven reports from the medical literature (both English and non-English speaking journals) for review. Only complications which required emergency abdominal operative intervention with fecal diversion were included., Results: These 2 cases occurred early in the surgeons' experience with SH (under 10 cases). Incomplete rings (doughnuts) of excised rectal tissue were noted in both patients. There have been a total of 13 patients reported from seven countries across three continents requiring emergency abdominal exploration and fecal diversion for complications related directly to SH. The complications noted in these 13 patients include: 9 cases of perforation, 6 cases of sepsis, 2 cases each of obstruction and Fournier's gangrene, and 1 case each of rectovaginal fistula and intra-abdominal hemorrhage. Seventy per cent of patients underwent abdominal exploration within 3 days of SH, 90% within 5 days. The age range was 24 to 77 years. Two of the 3 oldest patients did not survive the complication (68 and 77 years of age). Three patients succumbed to sepsis in the immediate postoperative period: one on postoperative day 4 after SH (Germany),one on postoperative day 6 after SH (Spain) and the third on postoperative day 10 after SH (US). The 2 mortalities from Europe occurred immediately after colostomy 4 days after SH (Germany) and immediately after re-exploration 6 days after SH and 5 days after initial colostomy (Spain). There have been a few reports of successful, non-operative management in select patients. Symptoms of abdominal pain, urinary retention, and fever after SH frequently herald these severe life-threatening complications., Conclusions: SH has resulted in potential serious morbidity and even mortality in the immediate postoperative period. As the procedure has spread in popularity around the world, so too, it appears, have these severe, life-threatening complications. These complications are often heralded by abdominal pain, urinary retention, and fever. Surgeons should be aware of all of the potential complications (and associated warning signs and symptoms) of SH.