Vacuum drainage of groin wounds after vascular surgery

✍ Scribed by G. Stansby; K. Dawson; M. Taliadoros; G. Hamilton

• Publisher: John Wiley and Sons
• Year: 1990
• Tongue: English
• Weight: 271 KB
• Volume: 77
• Category: Article
• ISSN: 0007-1323
• DOI: 10.1002/bjs.1800771042

✦ Synopsis

In his report (Br J Surg 1990; 77: 748) MacGowan suggests that 'all patients who undergo surgery should be regarded as potentially HIV positive' and that surgeons should 'avoid puncturing gloves' and be 'extra careful to avoid self-inflicted injury'.

I have yet to meet a surgeon who did not try to avoid self-inflicted injury. If nearly 50 per cent of surgical gloves are punctured, as MacGowan states, then puncture avoidance is clearly a non-starter. The true implications of treating every patient as HIV positive are enormous. Routine 'high risk' precautions including disinfection of theatres and equipment between each case would substantially reduce the number of cases on each operating list and and correspondingly increase the cost of surgery and the length of waiting lists.

It is suggested that if a surgeon is contaminated by an HIV positive patient he should be 'kept out of theatre' until repeated HIV tests are negative, but if we truly regard all patients as potentially HIV positive then surely this should apply to contamination by any patient, at leasf until the patient is shown to be HIV negative. Since contamination is such a frequent event, who will be left to do the operating? Such advice is not merely impracticable and unhelpful but also dangerously misleading. It gives the illusion of action while failing to face up to the true implications of the problem. Instead, the unfortunate surgeon who contracts HIV while operating will be blamed for failing to 'avoid self-inflicted injury'. This is cold comfort.