Surgical drapes made of cotton are under increasing competition with various disposable products and reusable draping systems (e.g., made of synthetic fabrics like polyester). When making a choice to use one of these medical devices in practical surgery, major aspects like handling, hygienic safety and costs, but also environmental effects have to be taken into account. In this study a mixed system for patient drapes (reusable cotton drapes combined with a reduced set of impermeable single-use drapes made of cellulose/polyethylene) was compared to a system that is only based on single-use drapes with regard to ecology [life-cycle assessment (LCA)]. The medical literature was reviewed to assess important medical aspects of the use of patient drapes, resulting in the statement that there are no conclusive arguments to support a clear hygienic superiority of one of these alternatives. Based on the conditions assumed and stated, the results of the LCA indicate that the mixed draping system is associated with two times more total energy consumption. In addition, more water is needed and more CO2 emissions are produced. However, draping with the single-use product results in more clinical waste. Regarding water pollution no system proved superior. It is difficult to compare and weigh various environmental aspects like the polluting cultivation of cotton in distant countries (reusable drapes) and the higher figure of transportation necessary to deliver the single-use product within Germany. It is an important disadvantage of the mixed system that it combines the ecological burden of both cotton drapes and the single-use alternative.