# Enhancing cadaver preparation protocol to reduce bacterial contamination in musculoskeletal allografts: a comparative study of battlefield fatalities and general population donors

## TL;DR

This study compares bacterial contamination in musculoskeletal allografts from battlefield and general donors, showing improved sterility with a new washing protocol.

## Contribution

A novel pre-operative washing protocol significantly reduces bacterial contamination in allografts from unsanitary conditions like battlefields.

## Key findings

- Tissues from battlefield casualties had higher contamination rates compared to general population donors.
- The new washing protocol significantly reduced contamination in battlefield-derived tissues.
- Current cadaver preparation guidelines may need revision for unsanitary condition mortalities.

## Abstract

Musculoskeletal allografts are becoming increasingly essential in orthopaedic and reconstructive surgery. A significant source of these allografts is tissues retrieved from deceased donors. While contributing substantially to the pool of allografts, these tissues are at increased risk of bacterial contamination. This risk is further amplified when tissues are procured from field casualties. In this study, we performed a side-by-side retrospective comparison of contamination rates in tissues retrieved from the general population and battlefield mortalities, representing field casualties. In response to the rising incidence of contaminated tissues obtained from field casualty donors, we implemented a more rigorous pre-operative washing protocol designed to maximize sterility. This protocol modification led to a significant decrease in the contamination ratio of tissues retrieved from field casualties. Our findings suggest that current pre-operative cadaver preparation guidelines may need to be reconsidered for tissue donations following unsanitary condition mortalities. Furthermore, these findings strongly suggest that field surgeries would benefit from a surgical pre-operative preparation designed specifically for incidents such as battlefields, accidents or mass casualty incident areas to minimize post-operative infections and improve surgical outcomes.

The online version contains supplementary material available at 10.1007/s10561-026-10208-4.