Abstract
BackgroundThe need for reoperation or wound infection treatments between pulsatile and gravity irrigation are statistically equivalent, however, it is unclear which method maximizes operative efficiency and expeditious irrigation. In this study we set out to determine the differences in irrigation rate between these various treatment methods.MethodsThis was an ex-vivo experimental laboratory study not involving human subjects. Irrigation rates were tested based on the time in seconds required to empty a three-liter bag of normal saline hanging at either 6 or 9 ft. Three forms of irrigation were tested: gravity irrigation (GI6, GI9), low-pressure pulsatile irrigation (LP6, LP9) and high-pressure pulsatile irrigation. One-way ANOVA and Student’s t-test were used to compare rates based on height and form of irrigation.ResultsSignificant differences in irrigation rates were noted at 6 ft between all three forms of irrigation with gravity irrigation the fastest followed by high-pressure and low-pressure pulsatile irrigation (GI6, mean 142 s ± 3.2; HP6, mean 189 s ± 10.2; LP6, mean 323 s ± 22.5; p < 0.001). This difference was also found at 9 ft (GI9, mean 114 s ± 1.5; HP9, mean 186 s ± 10.5; LP9, mean 347 s ± 3.5; p < 0.001). Gravity irrigation was significantly faster (p < 0.001) at an increased height, whereas the high and low-pressure irrigation rates were unaffected by height. List price comparison found pulsatile irrigation to cost approximately 3.3 times more than gravity lavage.ConclusionsGravity irrigation provided the most rapid rate of irrigation tested, regardless of the height. With existing literature demonstrating equivalent clinical outcomes between methods, gravity lavage offers a faster and potentially more cost-effective form of irrigation.
Highlights
The need for reoperation or wound infection treatments between pulsatile and gravity irrigation are statistically equivalent, it is unclear which method maximizes operative efficiency and expeditious irrigation
At irrigation height of 6 ft, significant differences in irrigation rates were noted between all three forms of irrigation (Table 1)
Gravity irrigation reported the fastest times followed by high-pressure pulsatile irrigation and low-pressure irrigation (GI6, mean 142 s ± 3.2; High pressure pulsatile 6 ft (HP6), mean 189 s ± 10.2; Low pressure pulsatile 6 ft (LP6), mean 323 s ± 22.5; p < 0.001, Table 1)
Summary
The need for reoperation or wound infection treatments between pulsatile and gravity irrigation are statistically equivalent, it is unclear which method maximizes operative efficiency and expeditious irrigation. In this study we set out to determine the differences in irrigation rate between these various treatment methods. Along with immediate antibiotic administration, thorough debridement and irrigation is a critical step in the management of infection prevention in patients with open fractures. High-pressure irrigation has traditionally been thought to be more effective at removing bacteria from tissues [1, 11, 12]. It has been associated with a greater degree of damage to bone and soft tissue and thought to potentially drive bacteria deeper into tissues [11, 13–18]. Results of the Fluid Lavage in Open Wounds (FLOW) trial have helped to establish that there are no significant differences in
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