Encuesta sobre el manejo de injertos del ligamento cruzado anterior contaminados accidentalmente

Resumen

Objetivo Encuestar a cirujanos de rodilla en Chile, sobre su conducta en contaminaciones accidentales del injerto, en reconstrucciones de ligamento cruzado anterior (LCA).

Métodos Se realizó una encuesta anónima en relación a la incidencia, tratamiento y resultados clínicos de los injertos de LCA contaminados, a todos los médicos pertenecientes al área de traumatología y ortopedia asistentes al congreso Ateneo de rodilla 2015.

Resultados Se encuestaron 54 médicos, 33 (61%) especialistas en cirugía de rodilla y 21 (39%) médicos en formación. De los cirujanos de rodilla, 15 (45%) reportaron al menos un caso de contaminación, de los cuales 12 (80%) informaron un único evento, 3 (20%) indicaron la eventualidad en 2, 3 y 5 ocasiones respectivamente, para un total de 22 injertos contaminados. De los cirujanos que reportaron injertos contaminados, 11 (73%) realizan 50 o más reconstrucciones al año. La decisión tomada en los casos de contaminación fue en 13 oportunidades (59%), lavar el injerto y utilizarlo de acuerdo al plan inicial; en 6 casos (27%), utilizar aloinjerto; en 2 ocasiones (9%), utilizar autoinjerto alternativo; y en 1 oportunidad (5%); triplicar el semitendinoso. Ninguno de los casos de contaminación reportó infecciones.

Conclusiones En casos de una contaminación accidental, la mayoría de los cirujanos encuestados prefieren optar por la descontaminación del injerto y su utilización en la reconstrucción de acuerdo al plan inicial; para lo cual la clorhexidina y antibióticos sería la solución a usar de preferencia.

Nivel de Evidencia Nivel V, opinión de experto.

Abstract

Objective To survey knee surgeons who perform anterior cruciate ligament (ACL) reconstruction in Chile, about the management when ACL graft contamination occurs.

Methods An anonymous survey was conducted to all physicians belonging to the area of traumatology and orthopedics who attended the 2015 annual Chilean Knee Society meeting. The survey questioned the incidence, treatment, and outcomes of ACL graft contaminations.

Results Fifty-four physicians were surveyed, of which 33 (61%) where knee surgeons and 21 (39%) physicians in training. Of the 33 knee surgeons, 15 (45%) reported at least one contamination during their career. Of those 15, 12 (80%) had one event, and three surgeons (20%) informed having 2, 3, and 5 episodes respectively, for a total of 22 reported contaminated grafts. Of the surgeons who reported a contaminated graft, 11 (73%) performed 50 or more ACL reconstructions annually. In 13 opportunities (59%) the management for a contaminated graft was cleansing the graft and proceeding as planned. In 6 cases (27%) an allograft was used, in 2 occasions (9%) a different graft was harvested, and in 1 opportunity (5%) a semitendinosus graft triplication was performed. No infections in any of the contaminated grafts were reported.

Conclusions In case of accidental graft contamination during an ACL reconstruction, knee surgeons most often preferred disinfecting the graft and using it as the initial plan.

Level of Evidence Level V, expert opinion.

Palabras clave

ligamento cruzado anterior - reconstrucción - injerto - contaminación - manejo - clorhexidina

Keywords

anterior cruciate ligament - reconstruction - graft - contamination - management - chlorhexidine

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