Re: Nonshaved cranial surgery in black Africans: a short-term prospective preliminary study (Adeleye and Olowookere, Surg Neurol 2008;69-72) Effect of hair on surgical wound infection after cranial surgery: a 3-armed randomized clinical trial. Does shaving the incision site increase the infection rate after spinal surgery? [Preoperative skin preparation. A prospective study comparing a depilatory agent in shaving]. Shaving versus skin depilatory cream for preoperative skin preparation. A prospective study of wound infection rates. Preoperative skin depilation and its effect on postoperative wound infections. [Chemical depilation as an alternative to shaving. A comparative study of preoperative skin preparation]. The influence of hair-removal methods on wound infections. Preoperative shaving: patient and surgeon preferences and complications for the Gillies incision. Pre-operative shaving and wound infection in appendectomy. Preoperative hair removal: a random prospective study of shaving versus clipping.
nan A prospective randomized clinical study.
                To determine whether shaving the incision site before spinal surgery causes postsurgical infection.
                Spine surgeons usually shave the skin of the incision site immediately before surgery is performed. However, evidence from some surgical series suggests that presurgical shaving may increase the postsurgical infection rate. To our knowledge, no previously published studies have addressed this issue.
                A total of 789 patients scheduled to undergo spinal surgery were randomly allocated into 2 groups: those in whom the site of operation was shaved immediately before surgery (shaved group; 371 patients) and the patients in whom presurgical shaving was not performed (unshaved group; 418 patients). The mean duration of anesthesia and the infection rates in both groups were recorded and compared.
                The duration of anesthesia did not differ in the 2 groups (P > 0.05). A postoperative infection developed in 4 patients in the shaved group and in 1 patient in the nonshaved group (P < 0.01).
                The shaving of the incision site immediately before spinal surgery may increase the rate of postoperative infection. Two types of pre-operative skin preparation were compared in a prospective randomized study conducted on 100 patients undergoing elective surgery: 51 patients were shaven (group I) and 49 were prepared with a depilatory agent. In all cases skin preparation was performed on the eve of the operation. Bacterial density, measured immediately before surgery by application of a contact agar preparation was 493 +/- 928 CFU in group I and 386 +/- 670 CFU in group II (NS). Bacterial density was less than 25 CFU in a significantly greater number of group II patients (P less than 0.01). On the second postoperative day, the number of scars without any sign of sepsis was significantly greater in group II patients (P less than 0.05). In addition, the depilatory agent proved bactericidal against 3 pathogenic strains (S. aureus, Pseudomonas aeruginosa and E. coli). Depilation with a chemical agent seems to be a satisfactory method of pre-operative skin preparation. It is more rapid than shaving, it can be applied to areas not easily accessible to razors, and it can often be carried out by the patient himself. A prospective, randomized study compared the effect of preoperative shaving versus chemical depilation on wound infection in 253 patients. No statistical difference was found between the two methods. Depilatory cream did save time by allowing hair to be removed the day before surgery and did offer an advantage in areas that were difficult to shave or if the patient was scheduled for diagnostic procedures and operations in the same operative area in close succession. nan nan The influence of preoperative shaving v clipping on wound infection rate was studied in 1,013 patients undergoing elective operations at a single hospital. Patients were prospectively randomized to be either shaved or clipped the night before or the morning of operation. The AM clipper method was associated with significantly fewer infections than were the other methods, both at discharge and at 30-day follow-up. The greatest benefit was in the group with clean wounds. For each 1,000 patients treated, a savings of approximately $270,000 could be realized if the AM clipper method replaced shaving for preoperative hair removal. Preoperative shaving is deleterious, and the practice should be abandoned. A modified technique for the Gillies temporal approach without previous hair removal is described. A randomized prospective study of two groups of patients requiring elevation of fractures of the zygomaticomalar complex via this approach with and without hair removal was performed with respect to patients' attitudes and surgeons' assessment. The study on the effects of shaving the skin on wound infections after appendectomy was done in 80 patients in 1988 in Siriraj Hospital. Patients were divided randomly into two groups, 40 patients each, a control and an experiment group. The control group had their skin shaved and the experiment group did not. Data showed no difference in: demography, preoperative admission time, interval between skin preparation and surgery, thickness of subcutaneous tissue, operating time, and suture materials. Shaving of the skin resulted in no alteration in bacteria found on the skin, on the walls of the wound before closing. Stitch abscesses were the only wound infection found in 3 patients in each group. It is concluded that skin shaving, though it did not increase wound infection rate, had no beneficial effect on wound infection in appendectomy. We report the results of a random, prospective study of electrical clipping versus routine razor shaving in the removal of hair immediately before operation. Two hundred patients having elective inguinal herniorrhaphy according to strict protocol were included in this study. Unsatisfactory skin preparation, as evidenced by gross cuts made in the skin during hair removal, was noted in 7% of those shaved and 4% of those clipped. Two subcutaneous wound infections occurred in the shaved group (2%) and one in the clipped group (1%). This study indicates that preoperative clipping of hair with electric barber's clippers immediately before operation is a safe, well tolerated procedure that does not increase the risk of postoperative wound infection.
Whilst this review found no statistically significant effect on SSI rates of hair removal insufficient numbers of people have been involved in this research to allow confidence in a conclusion. When it is necessary to remove hair, the existing evidence suggests that clippers are associated with fewer SSIs than razors. There was no significant difference in SSI rates between depilatory creams and shaving, or between shaving or clipping the day before surgery or on the day of surgery however studies were small and more research is needed.