This study addresses four questions: Does laminar flow exist in our operating theatres? Do perioperative warming blankets affect laminar flow? Do perioperative warming blankets cause displacement of particles into a wound perioperatively? Do conventional theatres have adequate airflow? It has been widely recognised that laminar flow theatres decrease colony forming units in operating theatres and thus decrease the risk of infection in arthroplasty surgery. It is also accepted that perioperative warming blankets improve patient haemodynamic stability and may reduce the risk of wound infection. However, there has been great debate as to whether these perioperative warming blankets cause disruption of laminar flow and excess displacement of dust into a wound, and thus increase the risk of infection of total joint arthroplasty surgery. Using digital video imaging and airflow measurement techniques as used in formula 1 racing design, this independent study reveals that the Bair Hugger system has no effect on laminar flow or paticle displacement. It also shows that factors out of the surgeon’s control disrupt laminar flow and that general theatre design may be inherently flawed. This would seriously affect the risk of infection.
A retrospective study of 32 patients with primary tumours of the cauda equina is presented. Most of the patients were initially diagnosed as having prolapsed intervertebral discs and treated accordingly. The correct diagnosis was eventually made, usually after a long delay, and confirmed by myelography. Treatment consisted of laminectomy and excision of the tumour. Only one tumour was frankly malignant; all the remaining patients were relieved of their pain and the majority recovered completely. The exceptions were those patients with long-standing neurological deficits; this highlights the importance of early diagnosis and correct treatment before irreparable damage occurs.
