Why do I have to take off my underwear for foot surgery?

October 20, 2015 7:14 PM

I had foot surgery in 2003 and I remember they made me take off ALL my clothes, including underwear, for the surgery. Why?

My wife is having foot surgery this Friday and I expect a similar "gown only" policy, and we're wondering why.

Are the odds really that high that they would need to do something down there during foot surgery? Does it happen so regularly that it has to be standard procedure? Are they going to save my life through my anus? What is up???

posted by arniec to Health & Fitness (19 answers total)

Did you have a catheter?
posted by melissasaurus at 7:17 PM on October 20, 2015

I assume it's because your undies aren't sterile. (Among other reasons that I'm sure will be posted.)
posted by Crystalinne at 7:20 PM on October 20, 2015 [4 favorites]

In case they have to catheterize you. Sorry, that's horrible but it's true, undies have no place in the OR.
posted by Lyn Never at 7:26 PM on October 20, 2015 [5 favorites]

Response by poster: I did not have a catheter, I wasn't even fully knocked out just twilight sleep.

But do catheters happen so often during foot surgery that all patients should be exposed?
posted by arniec at 7:30 PM on October 20, 2015 [1 favorite]

Because doctors, and the medical establishment, are control-focused and risk-averse.
posted by solitary dancer at 7:34 PM on October 20, 2015 [23 favorites]

But do catheters happen so often during foot surgery that all patients should be exposed?

That's not the question. They happen sometimes. And so, they want to be prepared for it, no matter how rare. The OR can become life or death very quickly, even in routine surgeries, and they don't want anything getting in the way.
posted by 256 at 7:46 PM on October 20, 2015 [14 favorites]

Something could go wrong while you're in surgery. They may have to access the rest of you to, yes, save your life.
posted by clone boulevard at 7:46 PM on October 20, 2015 [2 favorites]

It's not about the odds as much as it is about the stakes. The odds are pretty low that they would need to catheterize you, or access your abdomen, or restart your heart, or anything that would require access to any part of your body above the knee. But the stakes, if such a thing were required, are life and death. And when the stakes are that high, you want there to be absolutely nothing stopping the doctors from doing what they need to do to help you. So given that there's basically no downside to having everyone strip completely, that's what they do.
posted by decathecting at 7:49 PM on October 20, 2015 [26 favorites]

Also it frees them from liability for anything you might be wearing if blood gets splashed around.
posted by Mitheral at 7:59 PM on October 20, 2015

Have you sterilised all your stuff? Are the theatre staff confident you've sterilised all your stuff? I bet you the stuff they made you wear had been sterilised.
posted by pompomtom at 8:15 PM on October 20, 2015 [4 favorites]

I asked this question during instructions for surgery a while ago. The nurse told me it was because normal bleeding during surgery is often stopped by cauterizing. That causes a risk of fire. I guess they assume most people wear synthetic underwear, which would be BAD to catch on fire, so they just tell people not to wear underwear at all. I said, if I wear all cotton underwear though, that should be fine, based on that reasoning. She agreed, I wore it, and I guess I didn't catch on fire.

I have no idea if this is the whole story, and it sounds kind of ridiculous to me but that is what I was told.
posted by Tandem Affinity at 8:16 PM on October 20, 2015 [7 favorites]

Best answer: Your femoral vein (in your groin) is the easiest place to get a crash central line if things suddenly took a turn for the worse.

A "crash central line", which is an IV placed in a major blood vessel that can be used to infuse blood pressure maintaining medications, blood transfusions, etc, very quickly is done emergently, not under sterile conditions, but it's gross when you have to do it in the vicinity of where dirty underwear have been sitting.

As far as urinary catheters go, though, it would be vanishingly unlikely that anyone would need to place one of those so quickly they would need super-fast access to your genitalia. I don't think it's about that (although if they wanted to do so even urgently, I'm not sure how they'd take your underwear off aside from cutting it if they were doing surgery on one foot...

These are just some thoughts. I'm not a surgeon but I work resuscitations and the first thing we do is cut all the patient's clothing off, and groin access is a big deal in those situations.
posted by treehorn+bunny at 8:18 PM on October 20, 2015 [31 favorites]

The synthetic fabric/fire risk thing is probably BS because surgeons in the OR are all draped in polyester blend gowns, and they drape patients in the same material to create a sterile field.
posted by treehorn+bunny at 8:20 PM on October 20, 2015 [1 favorite]

there's also the shitting/pissing yourself factor. if you need to be cleaned up, it would be very inconvenient/unhygienic to have to remove your underwear.
posted by jayder at 8:21 PM on October 20, 2015 [2 favorites]

I'm not a surgeon, but my guess would be that there is a small but real risk that the electrosurgical instrument could ground on anything metallic on your underwear, especially in the presence of liquids (like blood) and cause a shock or burn. See here or here. Nothing metallic in your underwear you say? Why would you have blood up by your groin for a foot surgery? Well, there are a lot of different types of clothes out there, and I don't know that I could say for sure there was no metallic thread in some of my more elaborate underthings. There is also the cliched but true fact that people are weird. If you operate on enough folks, someone is going to come in with ankle-length undergarments,, or forget to take the switchblade out of their boxers (you think I'm joking, but I'm not).

And the last thing is that standardization in medicine keeps people safe. When you get an MRI, the tech tells you to take ALL of your jewelry off, they don't quiz you about whether your jewelry is ferrous or not and then let you keep the stuff that you don't think will be affected by the magnet. It's easier, faster, lower risk, and minimally inconvenient to ask people to remove all their jewelry (except for some piercings) and even less inconvenient to ask you to strip down.
posted by The Elusive Architeuthis at 9:53 PM on October 20, 2015 [1 favorite]

Well, contrary to a lot of what's being said here, when I went in for surgery on my broken arm a couple weeks ago (three pins had to be put in, I kinda sorta broke both bones and fractured the length and put 'em out of alignment and had bits of broken bone floating about), they gave me sterile undies. I was under general anesthesia.

And yeah, those garments are very definitely not natural fibers. That said, they're also clearly treated with something that I imagine is anti-flammable.

The idea is that you be as sterile as possible. Prepare to be given a sterile wash to use in a shower before surgery as well. In my case it was Betadine.
posted by fraula at 1:06 AM on October 21, 2015 [1 favorite]

When I had minor foot surgery, with the kind of anesthesia where you count backwards and wake up later, I only had to take off my socks and pants. I kept my underwear and shirt on, with one of those horrible little gowns over the top.

So the full stripping down isn't universal, though the reasons described above all make sense.
posted by Dip Flash at 4:38 AM on October 21, 2015

I once had oral surgery (like real surgery, where they rendered me unconscious with anesthesia and it took place in a hospital surgery ward, not a dentist's office) and I also had to wear only a hospital provided gown, no underwear. I asked the nurse why and she specifically told me it was because a) underwear are not sterile and b) in case they have to put a catheter in.
posted by katyggls at 7:36 AM on October 21, 2015

Although all of the reasons above are potentially good reasons for taking off your underwear, as Dip Flash said it isn't universally practiced. In the children's hospital where I work we deal with kids at an age where they may be very self-conscious about their body (think teens and older pre-teens) as well as younger kids who simply decide they won't get undressed without a fight. So we often let patients leave on underwear and sometimes other clothing if it won't be in the way, and if it is going to be a big deal to undress a patient but we need to we will just wait until they are asleep to take their clothes off rather than have a temper tantrum on the way to the OR.
posted by TedW at 5:00 AM on October 22, 2015