Problems with the Yankauer Sucker for Irrigating Wounds

Abstract

The described technique is innovative and any irrigation system that decreases the contamination and the risk of infection in open fractures should be encouraged. The Yankauer sucker has an in-built hole in the middle; the authors have not mentioned whether this hole is plugged during wound irrigation. I have used this system and have noted a number of pitfalls. Because of the hole in the Yankauer sucker, optimal wound irrigation would need an assistant. One hand is needed to hold the bag of normal saline and another hand is needed to plug the side hole; the assistant is required to apply some kind of a retractor to direct the irrigating saline in the right direction. The authors describe that the holes at the far end act as a sprinkler system. I wonder how this sprinkler system helps in removing debris and decreasing contamination. The disadvantage of this sprinkler system is that the irrigating fluid falls well away from the margins of a small size wound. There are four holes at the far end, all being at 90° to one another and are impossible to plug because of their proximity to the outlet. They are ideally meant for suction. This is a low-pressure system by gravity flow and might allow large quantity of fluid to be delivered to the wound but has pitfalls mainly in design. Madden et al.1 showed that the efficacy of irrigation increases directly with the pressure at which a solution is delivered to the wound. Although irrigation, diminishes bacterial count, only high-pressure flow has been shown to bring about significant reduction of bacteria and debris in each type of wound.2 This system is suitable for large wounds and can not be used as a high-pressure system as any increase in pressure on the bag would direct the fluid further away through the four side holes at the far end.