ChloraPrep Revisited

[orthro pt 74361]

Double edit-this thread does not allow the post I tried to post up, just one giant paragraph and no pictures.

This goes along with a previously closed thread from a few years back here(edit wrote the post up with hyperlinks and pictures but somehow the forum didn't accept them now when I post). Wanted to bring it up as this surgical prep antispetic has caused me some grief on my last orthopedic hardware removal surgery on March 6, 2014.

Nice little story before we start:

I was on a long South American motorcycle trip that I was completing in multiple sections, ride, store the bike, fly home work, and repeat. Well my last fly-n-ride section was cut short in Venezuela back in July 2012 when I had an early evening accident near the middle of the country North of the Orinoco River in a rural area. Falling off my motorbike while not paying attention to the road surface caused me to have a left boot-top spiral fracture of my left tibia along with some lesser fractures to the fibia, later confirmed on xray.

It was my first exposure to socialized medicine, I'll just say it leaves a lot to be desired lol. I had some good contacts in Caracas and told them of my situation and they came down to rescue me and my bike and get me delivered to a nice private hospital in the capital city of Caracas and introduce me to highly recommended orthopedic trauma surgeon with years of experience having graduated Medical School in the mid seventies. I was more than happy to get worked into his surgery schedule the following day less than 48hrs from my crash. It was a bit of a job getting all the pieces put back together along with removing a screw from a previous left medial ankle fracture, so removing one screw and adding twelve more plus a nice long plate affixed to the broken tibia, the fibula would heal on its own without requiring followup.Nice new hardware:

By far best thing about Venezuela healthcare is the black market exchange on the dollar, currently going through the roof at around 64BBolivars to $1us but at the time around 9:1 was still well above the official bank rate of 4:1 which made for much cheaper price than I could find in the United States for the same procedure. I was happy to be fixed up with the new screws and plate and after 5 day recovery in the hospital flew home to Oklahoma for my recovery.

My Venezuelan surgeon told me to have the hardware removed in a years time and told me to be sure to not crash like that again with my new hardware or my leg would be trashed for sure. I would promise to take it easy.Upon arriving home and settling back into some kind of normalcy I had to deal with some necrotic tissue loss that took an extremely long time to re-granulate into the wound around the most distal site of my long incision site,

eventually all healed back up after a few months. Following photo dated sometime around Jan 2013:

Being like so many others in the US, I was also one without health insurance coverage as I was doing a lot of travel on the bike and then uninsured contract work as a healthy bodied single mid 30 something, never sick nor allergic to more to anything than poison ivy. The one thing I have been blessed with since birth coming from my father's side was my ace in the hole that I'd hoped I'd never have to use-I had Indian blood, although only a small fraction, that would give me access to healthcare set up by Indian Health Services and some of these administered by local tribes. I was very fortunate to have had my ancestors sign up on the Dawes Rolls.

The followup of this accident was the first time I'd needed the services provided by the IHS and it went off to a dismal start. I work in the healthcare industry and have seen a fair amount of the inner workings but never been involved with the IHS before. I can positively say it is way better than Venezuelan socialized medicine with Cuban doctors lol but it does leave a lot to be desired but then again it's a free service so I will just shut up and be happy as a lark about it.

I was initially seen at a large local IHS hospital and then made the switch to being seen in my smaller local area tribal clinic which was my the best move I could make. I'd gotten set up to see a contract health (anyone outside of the IHS services) to review and followup the surgery I'd gotten down in South America. At the time the most important aspect was the tissue damage at the incision site healing up without getting infected, the fixation and setting of the bones had been a complete success and of the two different orthopedic doctors I'd seen both recommended the hardware be left alone.

Fast forward a little over a year and a half later, the skin had taken 6months post op to completely heal in and I was still experiencing a fair amount of discomfort and pain associated with the hardware in my leg. The doctor in Venezuela had recommended it be removed one year later and I was going on well over 1 1/2 years without much improvement in my gait, still limped about without being able to put any more load than a normal walk without the option to run or cut without a shudder of pain coming up the tibia. I'd come back from Venezuela weighing 186lbs and now had blossomed up to 230lbs as my body and diet did not appreciate the lack of activity lol. I scheduled an appointment to see my PCP at the tribal clinic and told him of my continued trouble with the leg and got the approval to seek the removal of the hardware. After an xray and CT earlier this year to verify the bone had healed enough I was scheduled for surgery March 6, 2014 first case of the morning thankfully.

Everything went off great and the surgeon was able to easily remove the screws marking the locations with the c-arm and making little incision sites for majority of them while only a smaller vertical incision at the most distal end to slide the plate out. I was glued up and bandage nicely for recovery and ordered to wear my moon boot to keep my leg/ankle immoblized as I recovered. I could already feel a difference

Then things started to take a turn for the worst. I'd already mentioned that I was a healthy, albeit a little overweight now, no medicine taking allergy free person other than poison ivy, 30 something patient with no problems other than than my leg full of hardware that was just fixed. Post op orders where to remove the dressings in 48hrs and shower and shower in same time period. Prior to surgery I'd wiped down with some clear antispectic wipes provided with no ill effects and after the surgery I was covered from mid-thigh all the way to my toes with blue/teal colored antiseptic wash that stained the skin. The incision sites where well bandaged with tegaderm-like dressings and then the leg wrapped in ace wrap when I went to recovery. I later found out after calling my surgeon's office that this blue/teal colored antispetic was Chlorprep brand and after doing a little web search leading me to find its main active ingredients being "chlorhexdine gluconate" and "isopropyl alcohol".The leg just after my first shower post op, no visible signs of any problems with neat dressings.

I know I'm not allergic to the alcohol but after those initial 48hrs+ I can say I must surely be allergic to Chlorprep because my whole left leg from mid thigh down to the toes is covered with rash coming from each hair follicle and itches like mad. This allergic outbreak came on with 72 hours post op. Below you can easily see all my new spots, isolated on left lower extremity except for a few place on my right leg that must have come into contact during those first night's rest after the operation.The first pictures I took over the outbreak reaction are one week post op, pictured below:

Pictures don't do the intensity of my allergic reaction, it seems to have possibly peaked this morning 1 week to the day since surgery. I've been taking otc generic Benadryl along with applying topical Hydrocortisone 1% and 2.5% daily with little improvement to show yet.

So after doing some searching on the net lead me to the discussion on AllNurses wanting to try and come up with some ideas as for a healthy non-hyper allergenic person having a reaction like this post op is an aggravation to say the least. I guess I can safely say that I'm allergic to Chlorhexidine Gluconate along with poison ivy. It seems to me that this could be a time exposure related event and it's possible the protocol for washing should be moved up to 24hr time frame instead of 48hr, in all honesty I did not wash until more like 55-60 hours post op and still then the reaction didn't occur until nearly 72hr post op. Curious to know since the previous thread is now more than a few years old and closed if others' broad experience with the use of Chlorprep antiseptic prep has seen an increased in allergic incidence. I will be avoiding it if and ever I go back to the table. Thanks for any response and for my long winded thread, I have little to do while I rest and recover with leg elevated my last little part of my 12 screws in Venezuela:whistling:

John

[traumaRUs, MSN, APRN]

Wow - what a bad accident. We can not provide medical advice. Our best advice is to continue to follow up with your medical providers that are very knowledgeable about your injuries. Please take care.