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Surg Infect (Larchmt). 2017 May/Jun;18(4):424-430. doi: 10.1089/sur.2016.252. Epub 2017 Mar 1.

Pressure Irrigation of Surgical Incisions and Traumatic Wounds.

Author information

1
MPA Healthcare Solutions, Chicago, Illinois; Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Surgery, University of New Mexico School of Medicine , Albuquerque, New Mexico.

Abstract

BACKGROUND:

Pressure irrigation of surgical incisions and traumatic wounds is commonly used to prevent infections. Commercial pressure irrigation devices have proliferated rapidly, but scientific validation of clinical benefit or appropriate use remains uncertain.

METHODS:

The published experimental and clinical investigations of pressure irrigation have been reviewed since the introduction of the Waterpik device in 1967 to identify the evidence for use to prevent soft tissue infections associated with injury wounds or surgical incisions.

RESULTS:

The published literature favors low pressure irrigation between 5-15 pounds/square inch (psi) for experimental removal of bacteria from contaminated tissues, with pressures higher being associated with soft tissue and bone injury. No experimental or clinical data have demonstrated improved benefit from pulsed over continuous lavage. Clinical studies have been very heterogeneous in patient populations and study design; meta-analysis was not feasible. High-risk abdominal operations may have lower surgical site infection rates with pressure irrigation. Pressure irrigation in fractures and joint replacement surgery has shown mixed results. The largest multi-center randomized trial showed no benefit of pulsed (8-10 psi) lavage over conventional continuous gravity irrigation of open fractures.

CONCLUSIONS:

Experimental studies have shown effective removal of bacteria and contamination, but with a potential risk of tissue injury or displacement of contamination deeper into the soft tissues. Rigorous clinical documentation has not validated the optimum flow or pressure characteristics of pressure lavage in clinical practice. There is need for randomized clinical trials to validate pressure lavage in the prevention of infections in soft tissue injuries or high-risk surgical incisions.

KEYWORDS:

inflammation; prophylaxis; surgical site infection; trauma; wound infection

PMID:
28437197
DOI:
10.1089/sur.2016.252
[Indexed for MEDLINE]

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