Lateral recumbency

Preparation of the limb is done outside of the operating room.

The entire limb is clipped circumferentially, starting from the vertebral column to distal to the carpus. The clipped hair is vacuumed.

The distal part of the limb is isolated with a non-sterile wrap in a way that allows the limb to be hung during the sterile scrub and draping.

A general scrub is done before bringing the patient into the operating room.

In the operating room, the limb is put into a hanging limb position. The limb is prepared for aseptic surgery by performing the final sterile surgical scrub.

Corner drapes are placed around the surgical site and secured with towel clamps. Self-adhesive drapes may also be used.

The surgeon captures the foot with a sterile drape, and a non-sterile assistant releases the distal limb from the hung position. The foot and distal limb are wrapped with a sterile drape.

Note: It is recommended to isolate the foot with an impermeable sterile barrier (eg, plastic bag or surgical glove) to prevent strike-through from fluids used in surgery.

The foot and distal limb can then be over-wrapped with sterile conforming bandage material or an impermeable surgical sleeve, as shown in the photograph.

An extremity or laparotomy drape covering the entire surgery table is recommended on top of the corner drapes. If a surgical sleeve has been applied, a hole can then be made to access the suyrgical site.

Access to the shoulder region should be ensured to allow for antegrade bone pinning or bone graft harvesting if required.

An antibacterial adhesive incisional drape is applied to the entire limb, either directly onto the skin (if no sleeve was used) or on top of the sleeve. The incisional drape should adhere firmly to the exposed skin.

If preferred, a sterile stockinette (rather than a surgical sleeve) can be applied over the entire limb, a hole made, and then the edges sutured to the edges of the skin incision.