Bag lavage: a closed method for pulse lavage irrigation

Abstract

High-pressure fluid irrigation (2–10 lb/sq in) is part of the standard of care in the treatment of heavily contaminated wounds. In both experimental and clinical studies, high-pressure fluid irrigation results in superior wound irrigation with lower bacterial colonization counts and infection rates as compared with other irrigation techniques. Use of a highpressure irrigation system results in lower subsequent infection rates for numerous injuries, including open fractures, particularly those involving open joints, as well as clean-contaminated and contaminated wounds, including appendectomies and lacerations with foreign material. Pulse lavage also is effective in the debridement of necrotic tissue. Based on these and numerous other studies it is widely accepted that high-pressure irrigation should be administered to all severely contaminated (grade III or IV) traumatic wounds, all open orthopaedic fractures, and is extremely useful in the management of severely infected wounds such as infected diabetic feet. Although highly effective, the traditional method of high-pressure irrigation in open containers can result in contaminated fluid being sprayed and aerosolized throughout the operating room. In addition to saturating the operating field and floor, this method may result in surgical staff being exposed to devitalized tissue, contaminated irrigation fluid spray, or aerosols. A modified closed high-pressure irrigation system using a bowel bag for irrigation of extremity, perineal, or head wounds is presented. This system markedly decreases irrigation saturation of the operative field and reduces the risk of exposure to operating room staff.