Streamlining wound washout: a novel method of wound irrigation

Abstract

Sir,Effective and thorough washout is an essential principlein the successful management of traumatic wounds. Me-ticulous wound excision is fundamental but decontami-nation prior to wound closure lowers the risk of infec-tion, foreign body retention, and pain for patients [1, 2].The merits of high- and low-pressure irrigation havebeen discussed elsewhere [3, 4]. We describe a simple,cheap, and highly effective method of wound irrigationthat produces a strong stream of fluid, ideal for a rangeof wounds treated by plastic surgery units. This methodfacilitates both operator independence and fluency in thesurgical procedure.A sterile bag of normal saline is attached to a sterilebasic fluid giving set. This fluid bag is placed onto thesurgeon’s stool (the less padded, the better), with thedistal end of the giving set kept in hand. By slowlysitting down on the bag, the surgeon’s body weightexerts pressure on the irrigation fluid (Fig.1). Manualcontrol is achieved by adjusting the valve on the givingset to produce a variable pressure of the resultant jet ofsaline projected onto the wound. As the bag empties,gentle sideways rocking facilitates the maintenance of auseful pressure for irrigation. Practice will enable all butafewdropstobeextractedfromthebagofsalineusingthis technique. The empty bag can be removed followinguse with no compromise to sterility.Modifications can be employed to preserve sterilityfor the attachment of further irrigation bags by usingspare drapes or instrument set wraps to cover thesurgeon’s seat. A more focused and higher pressuredfluid jet can be achieved if necessary by attaching tothe distal end of the giving set a shortened plasticcannula tip or a 23-gauge needle with the sharp endremoved using a clip to avoid sharps injuries (Fig.2).Similar fluid jet modifications have been applied else-where [3].