USE OF CHLORHEXIDINE ON PIN SITES

Use of chlorhexidine on pin sites

Dear Sirs

We read with great interest the well‐written article ‘Use of chlorhexidine‐impregnated patch at pin site to reduce local morbidity: the ChIPPS Pilot Trial’ published in January 2008. The findings support previous published results concerning the use of chlorhexidine in pin site care. However, the use of compresses moistened with chlorhexidine as dressings and pin site care once a week has been previous published in several articles. In our first study, we used compresses moistened with chlorhexidine solution 2 mg/ml (1) and in following studies chlorhexidine 5 mg/ml with alcohol (70%) 2, 3. In 2005, a publication from UK described a pin site care concept using compresses moistened with Hydrex (a chlorhexidine solution with alcohol) (4) well described in the method section of previous mentioned articles. A randomised study from Sheffield, UK was presented during autumn 2007 at the British Trauma Society annual meeting, using compresses moistened with Hydrex in comparison with the British consensus method of pin site care (5). The use of common sterile compresses moistened with chlorhexidine from a bottle is probably a considerable less‐expensive alternative than BIOPATCH antimicrobial dressings. BIOPATCH antimicrobial dressing is an exclusive product expressly for the rich western world.

The case mix of patients in pin site care studies is confounding the results and the authors have valued the risk of infection. However, there is no consideration made of the use of antibiotics during the treatment with external fixation. The use of antibiotics, prophylaxis as well as treatment, both oral and intravenous, is information that should be reported in pin site care studies that evaluate the effect of a specific factor or a concept of pin site care, for example more use of antibiotics less risk of infection. We look forward to read the randomised study that hopefully follows the pilot study.