AANA Lab Course 1002 -3rd Annual Fellows/Chief Residents-I Just Dropped My Graft on the OR Floor! Now What

I Just Dropped My Graft on the OR Floor! Now What_-Aman Dhawan, M.D.

Pdf Summary

This presentation by Dr. Aman Dhawan addresses the issue of accidentally dropping an ACL graft onto the floor during surgery, a stressful situation many surgeons face. Studies show 88% of sports medicine surgeons have encountered at least one contaminated graft during their careers. The key message is to remain calm, focus on managing the immediate situation, and worry about the cause afterward.<br /><br />Three management options exist for a dropped graft: cleaning/sterilizing and using it, switching to another graft source, or using an allograft. Evidence reveals that around 75% of contaminated grafts are effectively salvaged through cleansing without subsequent infections.<br /><br />The optimal sterilization agent is chlorhexidine, superior to alternatives like iodine or saline. Protocols vary but typically involve either an 8-minute irrigation with 3 liters of 2% chlorhexidine along with mechanical agitation and polymyxin Bacitracin rinses, or a 30-minute soak in 4% chlorhexidine followed by a triple antibiotic solution soak. Both methods have demonstrated 100% sterilization in studies. Due to potential chondrolysis risks, thorough rinsing after chlorhexidine use is important.<br /><br />Preventative strategies include the surgeon personally transporting the graft to the back table, wrapping it in a saline-soaked sponge, and placing it inside a sealed specimen container. This setup allows sterile recovery if dropped.<br /><br />In summary, dropped grafts are common but manageable with appropriate sterilization protocols readily accessible during surgery. Communication with patients about the incident is recommended. With these practices, no infections have been reported following the use of properly sterilized, previously contaminated grafts. The presentation emphasizes preparation, calm response, and adherence to evidence-based cleansing procedures to ensure patient safety.

Keywords

ACL graft contamination

sports medicine surgery

graft sterilization

chlorhexidine irrigation

graft cleaning protocols

allograft use

surgical graft handling

infection prevention

chondrolysis risk

patient communication