J Korean Neurosurg Soc.  2019 Jan;62(1):123-129. 10.3340/jkns.2017.0282.

Superficial and Deep Skin Preparation with Povidone-Iodine for Ventriculoperitoneal Shunt Surgery : A Technical Note

• Craven CL
• Thompson S
• Toma AK
• Watkins LD

• KMID: 2434354
• DOI: http://doi.org/10.3340/jkns.2017.0282

Abstract

OBJECTIVE
Ventriculoperitoneal (VP) shunt surgery is a common and effective treatment for hydrocephalus and cerebrospinal fluid disorders. Infection remains a major cause of morbidity and mortality after a VP shunt. There is evidence that a deep skin flora microbiome may have a role to play in post-operative infections. In this technical note, we present a skin preparation technique that addresses the issue of the skin flora beyond the initial incision.
METHODS
The patient is initially prepped, as standard, with. a single layer of 2% CHG+70% isopropyl alcohol. The novel stage is the "˜double incision' whereby an initial superficial incision receives a further application of povidone-iodine prior to completing the full depth incision.
RESULTS
Of the 84 shunts inserted using the double-incision method (September 2015 to September 2016), only one developed a shunt infection.
CONCLUSION
The double incision approach to skin preparation is a unique operative stage in VP shunt surgery that may have a role to play in reducing acute shunt infection.

Keyword

Wound infection, Surgical; Ventriculo-peritoneal shunt; PVP-Iodine; Skin; Surgical incision

MeSH Terms

2-Propanol
Cerebrospinal Fluid
Humans
Hydrocephalus
Methods
Microbiota
Mortality
Povidone-Iodine*
Skin*
Surgical Wound Infection
Ventriculoperitoneal Shunt*
2-Propanol
Povidone-Iodine

Figure

• 

  Fig. 1. A : Superficial incision. B : PVP-I soaked gauze is applied to the scalpel and the superficial incision for 1 minute. C : PVP-I is applied to the second incision. PVP-I : povidone-iodine.

• 

  Fig. 2. Skin preparation protocol for VP shunt insertion. VP : ventriculoperitoneal.

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  Fig. 3. A : Bacteria populating the superfical (upper stratum corneum) and deep layers (deep stratum corneum, epidermal layers and dermis). B : Elimination of the majority of surface organisms with the application of CHG-alcohol. C : First incision (superficial, less than 1 mm), into which deeper organisms that survived the initial CHG-alcohol application. D : Reduction of implanting microbes to deeper layers following application of PVP-I (due to anti-microbial properties and the added irrigation effect). CHG : chlorhexidine-gluconate, PVP-I : povidone-iodine.

Reference

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