Extent Of Soft Tissue Damage Research Articles

Experience of use of intraoperative computed tomography and navigation systems in minimally invasive surgery for lumbosacral spondylolisthesis

This article discusses the minimally invasive surgical technique for lumbosacral spondylolisthesis. The use of intraoperative computed tomography (iCT) and a navigation system significantly enhances the accuracy of screw placement and reduces the extent of soft tissue damage. From March 2018 to February 2024, 246 patients with lumbosacral spondylolisthesis underwent minimally invasive surgery with the use of iCT and navigation systems at the N.N. Burdenko National Medical Research Center of Neurosurgery of the Ministry of Health of the Russian Federation. Of the above-mentioned cases, spondylolisthesis was most commonly observed at the L4-L5 (126 cases) and L5-S1 (98 cases) levels. This article presents two clinical cases from this series demonstrating successful use of these technologies.

Factors affecting return to work time and functional outcome after low-velocity gunshot injuries related to foot in civilian population

BackgroundPurpose of this study was to identify factors affecting return to work time and functional outcomes after low-velocity gunshot injuries related to foot. Related complications are also analyzed. MethodThis study conducted as retrospective cohort study in tertiary care university hospital. Data on 26 patients obtained through retrospective database search. Type of causing weapon, anatomic location of wound, wound type according to Gustilo Anderson classification, extend of damage regarding injured structures, extend of soft tissue damage, duration of hospital stay, need of reconstructive surgery, return-to-work time, follow-up period and functional scores at final follow-up were recorded. Factors affecting functional outcome and return-to-work time were analyzed. ResultsTotal of 12 patients (46.2 %) experienced complications, with eight being deep soft tissue infections. The mean MFS score for the study group was 77.27 (±11.82). The mean MFS for the pistol group was 83.46 (±6.90), extent of soft tissue damage was an independent risk factor (OR 10.67, 95 % CI 1.70–66.72, p = 0.011) for poor outcomes. On average, patients took 10.12 months (±7.59) to return to work, the type of gun used was an independent variable associated with delayed return to work (OR 144, 95 % CI 8.04–2578.09, p = 0.011). ConclusionGunshot injuries related to foot can lead to a high rate of complications, loss of workdays, and permanent functional losses. Therefore, it is crucial to develop appropriate treatment plans and manage inevitable complications in these injuries. Level of evidenceLevel IV, Case series

Big data insights into predictors of acute compartment syndrome

BackgroundThere remain gaps in knowledge regarding the pathophysiology, initial diagnosis, treatment, and outcome of acute compartment syndrome (ACS). Most reported clinical outcomes are from smaller studies of heterogeneous patients. For a disease associated with a financial burden to society that represents billions of dollars worldwide the literature does not currently establish baseline diagnostic parameters and risk factors that may serve to predict treatment and outcomes. MethodsThis study looks at a very large cohort of trauma patients obtained from four recent years of the Trauma Quality Programs data from the American College of Surgeons. From 3,924,127 trauma cases - 203,500 patients with tibial fractures were identified and their records examined for demographic information, potential risk factors for compartment syndrome, an associated coded diagnosis of muscle necrosis, and presence of other outcomes associated with compartment syndrome. A recurrent multiple logistic regression model was used to identify factors predictive of fasciotomy. The results were compared to the reported results from the literature to validate the findings. ResultsThe rate of fasciotomy treatment for ACS was 4.3% in the cohort of identified patients. The analysis identified several clinical predictors of fasciotomy. Proximal and midshaft tibial fractures (P <0.0001) showed highest increases in the likelihood of ACS. Open fractures were twice (O.R [2.20–2.42]) as likely to have ACS. Having a complex fracture (P<0.0001), substance abuse disorder (P<0.0002), cirrhosis (P = 0.002) or smoking (P<0.0051) all increased the likelihood of ACS. Age decreased the likelihood by 1% per year (OR= [0.99–0.993]). Crush and penetrating injuries showed an important increase in the likelihood of ACS (O.R of 1.83 and 1.37 respectively). Additionally, sex, BMI, cirrhosis, tobacco smoking and fracture pattern as defined by OTA group and OTA subgroup had predictive value on actual myonecrosis. Fasciotomies for open tibial fractures were more likely to uncover significant muscle necrosis compared to closed fractures. Amputation resulted after 5.4% of fasciotomies. ConclusionThis big data approach shows us that ACS is primarily linked to the extent of soft tissue damage. However, newfound effect of some comorbidities like cirrhosis and hypertension on the risk of ACS imply other mechanisms.

The mangled extremity: assessment, decision making and outcomes.

The management of the mangled extremity continues to pose a significant challenge for ortho- paedic trauma surgeons. This article provides a comprehensive, up-to-date literature review on the assessment of complex limb injuries, and the variables that affect decision-making and outcomes in both limb salvage and amputation. Initial assessment involves using a systematic approach, saving life before limb, with early involvement of the relevant surgical specialities and multidisciplinary team. The decision to attempt limb salvage or perform amputation can be extremely difficult. Scoring systems can be used as a guide but should not be wholly relied upon; instead more emphasis should be placed on the surgeon's experience, extent of soft tissue damage, and patient factors and wishes. Outcomes following amputation versus limb salvage are comparable, with some studies suggesting amputation may be favourable. It is important to advise patients and families on what treatment is in their best interest so they can make an informed decision, and this must utilise a multidisciplinary approach.

Management of upper extremity arterial penetrating vascular trauma

Penetrating vascular injuries in the upper extremity are relatively uncommon; suboptimal treatment may result in significant morbidity including amputation. Arterial trauma accounted for 68% of amputations (24% in the upper extremity) during World War II. Although surgical techniques including microsurgical principles have matured, results vary secondary to the mechanism of injury, systemic factors, anatomic considerations and physiologic events.This annotated review article is based upon the literature and the author's 42 years of vascular trauma experience including over 1500 revascularizations and replantations. It discusses the complex interplay of associated injuries; the mechanism of injury, the location of the injury; the collateral circulation; the extent of soft tissue damage; the adequacy of debridement; the significance of pre-existing conditions; and magnitude of wound contamination. Based upon this evaluation, a guide to indications for arterial reconstruction is provided and a comprehensive management plan for vascular trauma may be derived.

Clinical and Radiological Outcome of Complex Proximal Tibia Fractures Managed with Hybrid/Ilizarov Fixator with or without Minimal Internal Fixation.

Complex high grade proximal tibia fractures with associated extensive soft tissue injury pose a management challenge. The timing of surgery and fracture fixation options depend upon the extent of soft tissue damage. Post-operative complications such as wound breakdown, infection and infected non-union are common in such cases managed early with open reduction and internal fixation. Such fractures can be treated with primary closed reduction and Ilizarov/hybrid fixator application. It is a retrospective cross sectional study conducted at two tertiary care multispecialty hospitals to report the mid-term clinical and radiological outcomes of complex high grade proximal tibia fractures. These injuries were managed by closed reduction and external fixation with/without minimal internal fixation as a definitive procedure and outcome measures were checked with serial radiographs and functional scores at a regular interval of follow up. 17 patients with Schatzker's type 5 or 6 proximal tibia fractures with soft tissue compromise were operated on at two tertiary care referral centres from 2017 to 2019. These cases were operated on by two experienced trauma surgeons. Periodic follow-up was done and radiological and functional progression noted from case records. Average time to union was noted to be 12.59 weeks and mean time of fixator removal was 21.4 weeks. At the end of 1 year of follow-up, average range of motion was 121.76 degrees, average WOMAC score was 74.81(63-82) and KOOS score was 78.24(63-85). 1. Hybrid/Ilizarov fixator method is a safe way of fixing high energy proximal tibia fractures. It is associated with a good functional outcome, less soft tissue complications and allows early weight bearing. 2. We recommend this method of treatment for complex high grade proximal tibia fractures.

Combination of mini locking plate and nitinol arched shape-memory connector for purely lateral malleolus fractures: technique and clinical results.

BackgroundLateral malleolus fractures occur frequently. The common techniques for fixing purely lateral malleolus fractures are often challenging, owing to the extent of soft tissue damage and fracture non-union. Herein, we report a new treatment that entails minimally invasive insertion and continuous compression of the broken ends as a novel technique, and evaluate its clinical results.MethodsThis study enrolled 21 patients (13 males and 8 females; mean age 32.06±3.45 years, range 23–69 years) with purely lateral malleolus fractures. Each patient underwent open reduction treatment with a mini locking plate for internal fixation and compression of the fracture end with an Arched Shape-Memory Connector (ASC). The clinical assessments were made using the American Orthopedic Foot and Ankle Society (AOFAS) scores, which were recorded at the final follow-up visit.ResultsThe patients were followed for an average of 14.7±1.2 months (range, 12–18 months). None of the patients showed surgical failure, and all of the purely lateral malleolus fractures healed in an average of 12.6±1.5 weeks (range, 10–16 weeks). The mean AOFAS score was 88.94 (range, 83–90).ConclusionsThe new treatment had beneficial outcomes for purely lateral malleolus fractures. Mini locking plates are minimally invasive for surgical intervention, and combined with continuous concentrated compression with an ASC to accelerate osseous healing, they aid in restoration of function and enable early rehabilitation with a low incidence of postoperative complications.

Predictors of functional outcome of surgical management in proximal tibia fractures

Background: Tibia plateau fractures constitute about 1% of all fractures and complex bicondylar fractures constitute 30% of all Tibial plateau fractures. These fractures pose an inherent difficulty in treatment due to the extent of soft tissue damage, fracture comminution, instability, displacement of articular fragments and increased risk of compartment syndrome. Present study was carried to find out functional outcome in different fracture management technique. Material and methods: A total 25 cases of tibial plateau fracture treated with different implants from April 2019 to September 2019 in Santokba Durlabhji Memorial Hospital were followed for minimum of 6months. Patients less than 18 years and more than 60 years of age, Compound trauma and fractures due to pathological conditions were excluded. Functional outcome was measured using Rasmussen’s grading system at 6month follow up. Results: Maximum study subjects (36%) were in age group of 31-40yrs, 80% had road traffic accidents as a mode of injury. 32% were of type V Schatzker fracture classification. 48% subjects were operated by ORIF with LCP Plating, 24% subjects were operated by LCP Plating plus CC screw, 20% were operated by bicondylar plating, 8% were operated by CC screw. Most of the subjects with plates had either excellent or good outcome. Conclusion: ORIF with plating gives excellent to good functional outcome with minimal soft tissue complications.

Avulsion Injuries of the Pelvis and Hip.

Avulsion injuries of the pelvis and hip region are typical injuries in adolescent athletes but can be found in adults as well. Typical sites for avulsion injuries include the origin/insertion of tendons and ligaments. Among adolescents, the not yet ossified apophysis is also frequently involved. The pelvis and hip are especially prone to such injuries due to their complex musculotendinous anatomy. Clinical history and physical examination in combination with the recognition of typical imaging findings are essential for correct diagnosis of these mostly acute, but sometimes also chronic injuries. This review article describes typical avulsion injuries of the pelvis and hip and illustrates common radiological findings. Taking current literature into account, there is a special focus on the trauma mechanism, clinical examination, typical imaging findings and clinical management. Detailed knowledge of musculotendinous anatomy and typical injury mechanisms allows a correct diagnosis of avulsion injuries often only based on clinical examination and radiographic findings. Further imaging with ultrasound and MRI may be necessary to evaluate tendon retraction in non-osseous avulsion injuries and extent of soft-tissue damage. Knowledge of potential complications of acute/chronic injuries can help to avoid unnecessary examinations or invasive interventions. Conservative management of avulsion injuries usually leads to functionally good results. However, in the case of competitive athletes, relatively wide bone fragment dislocation or marked tendon retraction, operative re-fixation may be considered in order to expedite the rehabilitation process. · Avulsion injuries are common injuries at the pelvic region especially in adolescent athletes, due to not yet ossified apophysis.. · Excellent anatomical knowledge is essential for proper diagnostic evaluation and predicting the mechanism of injury.. · Imaging plays a crucial role in diagnosing avulsion injuries starting from X-Ray and using MRI and CT for anatomical details by utilizing multiplanar capabilities.. · Albtoush OM, Bani-Issa J, Zitzelsberger T et al. Avulsion Injuries of the Pelvis and Hip. Fortschr Röntgenstr 2020; 192: 431 - 440.

Imaging Predictors for Significant Lower Motor Neuron Injury in Traumatic Cervical Spinal Cord Injury

Abstract INTRODUCTION Traumatic spinal cord injury (SCI) results in loss of both white and grey matter in the spinal cord and adjacent to the site of impact. Loss of gray matter within the injured area leads to lower motor neuron (LMN) injury, due to direct destruction of the alpha motor neurons and associated axonal loss within the adjacent peripheral nerves. The extent of gray matter loss can be discrete, or it can extend multiple levels from the site of impact. Since these changes can become irreversible within a year after injury, early identification of significant LMN injury in patients with traumatic SCI allows them to benefit from available reconstructive surgeries before the window for reinnervation closes. METHODS In this single-center retrospective study the charts of 21 previously healthy individuals aged 15 to 50 yr who suffered traumatic SCI with AIS C4-C8 A-D classification and hand functional impairment, without concomitant peripheral nerve or brachial plexus injury, were reviewed. Magnetic resonance (MR) images of cervical spine, obtained within 6 wk from the injury, were reviewed to identify structural imaging characteristics that correspond to gray matter destruction. Severity of LMN injury predicted by imaging findings was compared with the results of compound muscle action potential (CMAP), motor unit potential (MUP), intraoperative stimulation, and Medical Research Council (MRC) grading of the major muscle groups of the upper extremity. RESULTS The extent of LMN injury as determined by electrophysiological evaluations and intraoperative stimulation could be predicted with some degree of specificity by the preoperative imaging findings. CONCLUSION In this study, simple imaging biomarkers indicate the extent of LMN injury in patients with traumatic SCI. By noting the extent of soft tissue damage within the injured metamere of the spinal cord, the degree of lower motor neuron injury can be anticipated and thus appropriate triage performed.

Increased perioperative C-reactive protein and decreased postoperative albumin is associated with acute posttraumatic osteomyelitis in patients with high-energy tibial fractures

BackgroundEarly diagnosis of acute posttraumatic osteomyelitis (POM) is of vital importance for avoiding devastating complications. Diagnosing POM is difficult due to the lack of a highly specific and sensitive test, such as in myocardial infarct, stroke and intracranial bleeding. Serum inflammatory markers, C-reactive protein (CRP), procalcitonin (PCT), white blood cells (WBC) can support clinical findings but they are not able to differentiate between inflammatory response to infection and the host response to non-infection insult with high specificity and sensitivity. AimThe objectives of the study were to investigate whether the biochemical and immunoinflammatory patient profile could facilitate postoperative monitoring, guide the antibiotic treatment and timing of revision surgery. Patients and methodsThis prospective nonrandomised cohort study included 86 patients after high-energy injury to the shin requiring primary surgical treatment (open or closed reduction and internal fixation of tibial fracture). Values of the biochemical and immunoinflammatory profile were measured on admission (ADD), first postoperative day (POD1) and fourth-postoperative day (POD4). ResultsWe discovered on our sample that the development of POM is associated with increased CRP on ADD, POD1 and decreased albumins on POD4. Further studies are needed to prove that these differences can be useful in diagnosing the risk of infection. The assessment of other important risk factors such as: the extent of soft tissue damage, multiple fractures, transfusion rate, need for conversion primary external fixation to intramedullary (IM) nailing or locking plate fixation can empower our clinical judgment of POM. ConclusionsWe can improve prediction of posttraumatic osteomyelitis by using the perioperative inflammatory biomarker CRP in combination with postoperative albumins levels and other associated independent risk factors.

Acute appendicitis complicated by necrotizing fasciitis in a teenager

Abstract Necrotizing fasciitis is a rare complication of appendicitis in children and is associated with significant morbidity and mortality. We present the case of a 16-year-old male who presented with perforated appendicitis and subsequently developed necrotizing fasciitis of the abdominal wall and perineum. His seven-week hospital course was notable for 16 trips to the operating room, which culminated in staged, complex abdominal wall repair. Ultimately he was discharged home in good condition. The case is remarkable for the extent of soft tissue damage and complexity of repair precipitated by an uncommon complication of a common pediatric disease.

Management of distal limb skin defects in dogs and cats

Skin defects on the lower limb are common and their management is usually challenging. All trauma patients should be initially assessed for concurrent injuries and stabilized. Debridement and cleansing is performed in all wounds. The most important factors for decision making on wound closure are the wound size, the extent of soft tissue damage, the presence of contamination and impaired perfusion. Primary closure is the preferred choice although; it is seldom applicable in wounds on the distal limbs. Delayed primary closure, secondary closure or second intention healing can be undertaken under certain circumstances in such wounds. When these options are not feasible local pedicle flaps, axial pattern flaps, distant flaps, grafts, muscle or myocutaneous flaps and microvascular free tissue transfer can provide coverage.

Intraoperative arthroscopy of the TMJ during surgical management of condylar head fractures: A preliminary report

PurposeThe purpose of this preliminary study was to evaluate intraarticular soft tissues of the temporomandibular joint (TMJ) using intraoperative arthroscopy during open reduction and internal fixation (ORIF) of condylar head fractures (CHF). Materials and methods26 patients (29 joints) were diagnosed in period of 5 years (2011–2015) with CHF, 5 patients had concomitant mandibular fracture. Fractures were diagnosed on basis of conventional orthopantomogram (OPG) and computed tomography (CT). ResultsIntraoperative arthroscopy revealed hyperemia and hypervascularity in all 29 joints, anterior disc dislocation in 26 joints, cartilage erosion in 21 joints and hemorrhagic clots were present in 10 joints. Major hemarthrosis or tear of the posterior band, as often described in MRI, could not be shown in our patients. Data from the study further the understanding of intraarticular pathology of the TMJ after acute trauma in a group with CHF. ConclusionIntraoperative arthroscopy is useful for direct evaluation and accurate diagnosis of the extent of soft tissue damage to TMJ in CHF. Larger and more long-term studies including comparison to MRI findings should be helpful to refine the treatment and postoperative management of patients after CHF.

Predictors of outcome after primary flexor tendon repair in zone 1, 2 and 3.

We retrospectively reviewed the outcomes of flexor tendon repairs in zones 1, 2 and 3 in 356 fingers in 291 patients between 2005 and 2010. The mean (standard deviation) active ranges of motion of two interphalangeal joints of the fingers were 98° (40) and 114° (45) at 8 weeks postoperatively and at the last follow-up (mean 7 months, range 3-98), respectively. Using the Strickland criteria, 'excellent' or 'good' function was obtained in 95 (30%) out of 322 fingers at 8 weeks and 107 (48%) out of 225 fingers at the last follow-up. A total of 48 (13%) fingers required reoperation because of rupture, adhesion, contracture or other complications. The prevalence of rupture was 4%. We carried out multiple linear regression analysis to identify the predictors of the active digital motion. The following variables were found as negative predictors: age; smoking; injury localization between subzones 1C and 2C; injury to the little finger; the extent of soft tissue damage; concomitant skeletal injury; delay to surgery; use of a 2-strand Kessler repair technique; attempted suture or preservation of the tendon sheath-pulley system; and resecting or leaving the concomitant superficial flexor tendon cuts untreated. Analysing the 8 weeks results of tendon repairs in zones 1 and 2, early active mobilization was found to be superior to Kleinert's regime. III.

Minimally Invasive Plate Osteosynthesis of Distal Tibia and Fibular Fractures Through a Single Distal Anterolateral Incision

Treating distal tibia fractures is often challenging given the extent of soft tissue damage around the fracture and the risk of infection and other complications with internal fixation and the accompanying incisions. Minimally invasive plate osteosynthesis minimizes these complications and can be performed through a single incision. From April 2009 to January 2011, we treated 20 patients who had both tibial and fibular distal fractures through a distal anterolateral approach with this technique. The mean follow-up period was 15.5 (range 12 to 26) months. The mean interval to bony union was 21 (range 18 to 25) weeks. A 5° varus deformity was found in 1 patient. Another patient, who had a history of alcohol consumption and smoking, developed wound necrosis that was treated successfully with debridement and without skin grafting. The mean American Orthopaedic Foot and Ankle Society score for all patients was 91.8 (range 84 to 97). The anterolateral, minimally invasive plate osteosynthesis technique is a useful method for treating distal tibial and fibular fractures at the same level, with a low complication rate.

Intramedullary Nail for Open Tibial Fracture

The tibia is particularly susceptible to open fractures because of its subcutaneous location. The status of the overlying soft tissue is regarded as the key determinant of fracture management strategy. Intramedullary nailing is widely recognized by the orthopedic community as the treatment of choice for most displaced, open, tibia shaft fractures due to the extent of soft tissue damage and the risk of infection. Both open and closed fractures are amenable to nailing. Occasionally, plates and external fixators are required to manage certain tibial fractures. This article describes the stabilization of an open tibia shaft fracture using an intramedullary nail. After copious irrigation and debridement of the fracture site, a transpatellar tendon split is used to expose the nail entry point. This is followed by fracture reduction, sequential reaming, and nail insertion and locking. Finally, the technique for proximal tibia traction pin insertion is demonstrated on the contralateral tibia.

Prognostic factors in distractive extension injuries of the subaxial cervical spine.

The subaxial spine has high risk of fatal damage by trauma and thereby requires more accurate and aggressive treatment. For the proper treatment and predicting the prognosis, the evaluation to reveal the risk factors for the prognosis is important. We analyzed the various factors contributing to the prognosis in distractive extension injuries of the subaxial cervical spine. The study included 103 patients who were diagnosed as distractive extension injury of subaxial cervical spine. We evaluate the patient age, sex, cause of injury, initial neurological impairment, number and portion of injured segment, spinal stenosis, extent of soft tissue damage, ossification of the posterior longitudinal ligament, and degenerative spondylosis as a prognostic factor. To analyze the factor related with prognosis, the subjects were divided into group A, in which patients had neurological recovery ≥grade 2 on the ASIA scale or showed normal in final follow-up and group B, in which patients have no neurological recovery. Prognosis was not associated with age, sex, and cause of injury (P = 0.677, 0.541, and 0.965, respectively). Prognosis was poor in cases with spinal stenosis (P = 0.009), soft tissue damage ≥grade 3 on magnetic resonance imaging (MRI) (P = 0.002), or severe neurological impairment (P ≤ 0.001). Logistic regression analysis also showed that prognosis was poor in cases with spinal stenosis (OR 5.03; 95% CI 1.20-16.93), soft tissue damage ≥grade 3 on MRI (OR 7.63; 95% CI 1.86-31.34), or severe neurological impairment (ASIA C, D, OR 0.59, 95% CI 0.14-2.41; ASIA A, B, OR 18.43, 95% CI 1.64-207.69). The prognosis of patients with distractive extension injury of the subaxial cervical spine was poor in cases with spinal stenosis, severe soft tissue damage in MRI findings or severe initial neurological impairment.

Outcomes of popliteal vascular injuries at Sri Lankan war-front military hospital: Case series of 44 cases

Background and aimsTraumatic injury to the popliteal vascular zone remains a challenging problem on the modern battlefield and is frequently associated with more complications than other vascular injuries. Limb salvage and morbidity (graft infection, thrombosis and delayed haemorrhage) were studied. Materials and methodsAll popliteal vascular injuries over an 8 month period admitted to the Military Base Hospital were analyzed. Local limb evaluation included confirmation of the presence of ischaemia, extent of soft tissue damage, muscle viability after calf fasciotomy, and neurological injury. Ischaemic time was recorded from the time of injury to definitive revascularization. If there was a prior attempt at reconstruction, the amputation was considered delayed. ResultsFor a series of 44 patients with popliteal vascular injury average time to presentation was 390min, 46% were completely ischaemic. Of those 39 (89%) had popliteal artery injuries. There were 24 (62%) complete popliteal artery transections and associated venous (69%) and osseous (46%) injuries. The preferred technique of repair was inter-position venous graft (IPVG) (54%). Eleven immediate amputations were performed (28%). There were 13 wound infections (33%), 5 early graft thromboses (5 of 21 IPVG, 238%), 2 anastomotic disruptions (2 of 21 IPVG, 9%), which resulted in 4 delayed amputations. Mortality was 5% (2 patients). ConclusionsIn this case series of popliteal artery injury early identification of limbs at risk, early four compartment fasciotomy, temporary intra-luminal shunting, definitive repair of concomitant venous injuries and aggressive treatment of haemodynamic instability were shown to be beneficial in achieving reasonable outcome in an austere environment with limited recourses.

Comparison of tissue damage, cleansing and cross‐contamination potential during wound cleansing via two methods: lavage and negative pressure wound therapy with instillation

The use of lavage was compared to negative pressure wound therapy (NPWT) with instillation (NPWTi) to assess extent of soft tissue damage, debris removal and environmental cross-contamination susceptibility in three distinct models. Scanning electron microscopy in an ex vivo model showed increased visible tissue trauma from lavage treatment at low and high pressures versus NPWTi, with the degree of trauma relative to the pressure of the irrigant. These results were corroborated in granulating full-thickness excisional swine wounds coated with dextran solution to simulate wound debris. Both low-pressure lavage and NPWTi demonstrated effective cleansing in this model, reducing debris by >90%. However, using three-dimensional photography to evaluate tissue damage by measuring immediate tissue swelling (changes in wound volume and depth) showed significantly greater (P < 0.05) swelling in low-pressure lavage-treated wounds compared with NPWTi-treated wounds. Lastly, bench top wound models were inoculated with fluorescent bacterial particles to assess environmental cross-contamination potential and collected at measured distances after treatment with low-pressure lavage and NPWTi. No evidence of cross-contamination was found with NPWTi, whereas one-half of the particles became 'aerosolised' during low-pressure lavage (P < 0.05). Collectively, these studies demonstrate the effective wound cleansing capabilities of NPWTi without the tissue damage and environmental contamination associated with lavage.