Low-pressure Irrigation Research Articles

Perceived benefit of antibiotics irrigation before pharyngeal repair of severe cut-throat injuries

IntroductionWound irrigation has been employed as an important surgical step to remove bacteria, devitalized tissues, and foreign bodies from surgical sites to prevent infection and confer to the wound maximum potential of healing. MethodA prospective study was conducted at Federal Medical Centre, Gusau, between January 2019- August 2023 to assess the benefit of antibiotics as additives in irrigation of dirty wounds.Seven (7) patients in total were presented with severe cut-throat injuries that require laryngopharyngoplasty. A combination of injection ciprofloxacin and metronidazole were used as additives into 1 L of normal saline, low pressure irrigation was done using 20mls syringe fitted to a broken needle or canular. Dysphagia Outcome and Severity Scale (DOSS) was used to assess return of pharyngeal function. ResultThe mean time of presentation of the patients was 34 ± 29 h (µ ± standard deviation) and a range of 6–72 h. The mean repair time was 58.3 ± 38.4 h with a range of 24–120 h. Most of the patients (85.7 %) had dysphagia outcome and severity scale of level 5 when per oral feeding was started with steady progress until discharge day. ConclusionWound irrigation is one of the most crucial steps in treating severe cut-throat injuries. Based on our experience, adding antibiotics to the irrigant has shown potential in the control of local infection, particularly where patients present late.

Intraoperative Wound Lavage System for Deep Neck Infection: A Retrospective Cohort Study.

Introduction Multiple solutions are currently used to cleanse a deep neck infection (DNI), and a variety of devices are available to deliver wound irrigation solutions. An essential difference between these devices is the pressure that the irrigation solution exerts over the wound tissue. Objective To compare low-pressure and high-pressure irrigation delivery systems for wound cleansing in DNI. Methods we designed a retrospective cohort study and reviewed the medical records of patients operated on due to DNI from June 2016 to December 2017 at our institution. One cohort included patients treated with an intraoperative irrigation method that exerts low pressure over the irrigated tissue, and the other cohort, to a system capable of generating higher pressure. The Pearson Chi-squared test was used to analyze the data. Results A total of 42 patients whose ages ranged from 16 months to 72 years were included. The low-pressure irrigation system was used in 18 patients, and the high-pressure system was used in 24 patients. No statistical differences were observed regarding the irrigation methods, the complexity of the DNI, and the overall outcomes. Conclusions The present is the first study in which low- and high-pressure systems for wound lavage were evaluated in the treatment of DNI. When comparing these methods, we did not find one to be superior to the other; however, the additional cost associated with the high-pressure devices may not justify their in head and neck procedures.

FERTIGATION DISTRIBUTION WITH LOW PRESSURE MULTIGATE IRRIGATION SYSTEMS IN A SUGARCANE AGROECOSYSTEM

In the state of Veracruz, Mexico, low sugarcane yields are reported despite the high use of inputs. This results in economic losses and environmental pollution. A fertigation system designed at the Colegio de Postgraduados (COLPOS) Campus Veracruz was established to determine the uniformity and stability of fertilizer distribution in the sugarcane crop. This study was carried out in a sugarcane plot with a farmer participant. Three levels of valve openings at the injector inlet (1/3, 2/3, and 3/3) were tested to determine the homogeneity of fertigation at the outlet of the gates and the stability of the system over time. Samples of water-fertilizer mixture were taken at the outlet of the gates. They were analyzed in the laboratory with a UV-visible spectrophotometer at 202 nm for nitrogen. It was found that the 1/3 and 3/3 valve position openings caused instability in the system. For the 2/3 opening with p = 0.359, no statistical difference (α= 0.05) was found during the time of emptying the container of the water-fertilizer mixture. Therefore, the fertigation system proved to be stable with a valve opening close to 2/3. Using the valve openings, the flow rate of water-fertilizer entering the system is uniformly mixed at the outlets of the multi-gate pipeline that pours into the crop furrows (p = 0.474 and α = 0.05). It can be concluded that in fertilization using a low-pressure irrigation system, nitrogen fertilizer is uniformly distributed when a Venturi type injector is used in a sugarcane agroecosystem with a valve opening close to 2/3.

Initial suction drainage decreases severe postoperative complications after pancreatic trauma: A cohort study.

Few studies have addressed the question of which drain types are more beneficial for patients with pancreatic trauma (PT). To investigate whether sustained low negative pressure irrigation (NPI) suction drainage is superior to closed passive gravity (PG) drainage in PT patients. PT patients who underwent pancreatic surgery were enrolled consecutively at a referral trauma center from January 2009 to October 2021. The primary outcome was defined as the occurrence of severe complications (Clavien-Dindo grade ≥ Ⅲb). Multivariable logistic regression was used to model the primary outcome, and propensity score matching (PSM) was included in the regression-based sensitivity analysis. In this study, 146 patients underwent initial PG drainage, and 50 underwent initial NPI suction drainage. In the entire cohort, a multivariable logistic regression model showed that the adjusted risk for severe complications was decreased with NPI suction drainage [14/50 (28.0%) vs 66/146 (45.2%); odds ratio (OR), 0.437; 95% confidence interval (CI): 0.203-0.940]. After 1:1 PSM, 44 matched pairs were identified. The proportion of each operative procedure performed for pancreatic injury-related and other intra-abdominal organ injury-related cases was comparable in the matched cohort. NPI suction drainage still showed a lower risk for severe complications [11/44 (25.0%) vs 21/44 (47.7%); OR, 0.365; 95%CI: 0.148-0.901]. A forest plot revealed that NPI suction drainage was associated with a lower risk of Clavien-Dindo severity in most subgroups. This study, based on one of the largest PT populations in a single high-volume center, revealed that initial NPI suction drainage could be recommended as a safe and effective alternative for managing complex PT patients.

Design of Venturi-Type Fertilizer Injectors to Low-Pressure Irrigation Systems

Twenty prototypes of Venturi-type fertilizer injectors for low-pressure agricultural irrigation systems were designed based on functional hydraulic pressure head and variation of their structural designs. These prototypes were modelled in three dimensions (3D) and evaluated using simulation through Computational Fluid Dynamics software (CFD). The main structural design characteristics come from a real necessity to complement an low pressure multigate irrigation system project named in Spanish “El Manzano” (The Apple tree) and bring it the fertigation possibility. The aim of this research was to select the best prototype, in order to identify the convergent and divergent angles, throat diameter and hydraulic pressure head to efficiently produce a Venturi-type injector for use in gated-irrigation pipe irrigation systems for use in a future in “El Manzano” project. As a result of the simulations, the physical characteristics of the injector were defined. The inlet and outlet diameters should be 152.4 mm, the throat diameter 76.2 mm and the suction diameter of 50.8 mm. The convergent and divergent angles showing most improved performances were 7.5 and 10°, respectively. This methodology can be used to construct Venturi-type fertilizer injectors for low-pressure gated-pipe agricultural irrigation systems, which, on one side, can reduce significantly the fertilizer application costs and, on the other side, the fertilizer management efficiency can be also improve considerably to save water resources. There is relatively very little experience in using this type of fertilizer injectors in low-pressure irrigation systems.

Simple ETo-Based Rules for Irrigation Scheduling by Smallholder Vegetable Farmers in Laos and Cambodia

Hand-held hoses and watering cans are widely used by smallholder farmers to irrigate vegetables in Cambodia and Laos. Overwatering is common. Technology change (e.g., low-pressure drip irrigation) has been used to improve irrigation efficiency but can be unaffordable for many smallholder farmers. The purpose of this study was to identify an appropriate method of predicting crop water demand, develop and field-test improved irrigation schedules for smallholder leafy vegetable farming based on that method, and then develop extension tools to communicate the schedules to smallholder farmers. Improved irrigation schedules for leafy vegetables were developed based on a crop water use prediction technique that is well established (the Penman–Monteith method) but beyond the capacity of smallholder farmers to implement without access to simple aids. Compared to conventional practice, the method approximately halved water and labour use and improved irrigation water productivity 2–3 fold in field research and demonstration trials. Simplified extension tools to assist smallholder farmers with practice change were developed. This work showed that significant efficiencies could be gained through improved irrigation scheduling without changing application technology.

The Effectiveness of Bedside Low Pressure Irrigation on Pistol Caliber Gun Shot Wounds Bacterial Contamination

Controversy exists regarding the benefit of low-pressure irrigation of pistol caliber gunshot wounds. Our study set to examine the effect of low-pressure irrigation on bacteria quantity in a simulated gunshot wound.

Технология капельного орошения картофеля с применением низконапорной полустационарной малообъемной системы

The article describes the results of field and laboratory experiments on the study of the technology of drip irrigation of potatoes via using the semi-stationary low-pressure small-capacity drip irrigation system (LDIS) developed by us. Reinforced aluminium micro-tubes ensure uniform watering. Depending on the annual precipitation sufficiency, the potatoes irrigation requirements 1700…3400 m3/ha, the number of irrigations varied from 10 to 20 times, and the yield was between 54…58,2 tons per ha.

Timing of debridement of open tibial fractures during the COVID-19 lockdown in India

Introduction and Purpose: Open tibia fracture is a common orthopedic emergency, requiring management with adequate surgical debridement, fracture stabilization, and the administration of intravenous antibiotics to ensure good outcome. They are more prone for non-union due to poor soft-tissue coverage, blood supply and increased risk of post-operative infection. The 6-hour golden rule for debridement has been the norm, despite lacking strong evidence to support it. The COVID -19 pandemic has challenged this age-old dictum due to resource constraints. Early debridement may preclude COVID testing and pose unjustified risks to patient and hospital staff. Delayed surgery in these times might be a more pragmatic approach.Aim: The primary focus of this study was to analyse the outcomes of open tibial fractures at 5months post-operatively with respect to infection and fracture union.Material and Methods: Study was designed as a prospective cohort study with convenience sampling during the period of 54 days of lockdown starting from 25 March 2020 at a tertiary care trauma centre in Kerala, India. All patients with open tibial fractures were managed with advanced trauma Life Support (ATLS) protocol. Intravenous antibiotics were administered within 6 hours. Adequate surgical debridement and low pressure irrigation was done after COVID testing (TRU-NAT/CB-NAAT/RTPCR) as per hospital protocol.Results: Of a total two hundred forty four patients, thirty two patients satisfying inclusion criteria with unilateral open tibial fracture were considered. Average time to surgical debridement was 5hr 52min + 2hr 58min. Majority of the patients being brought to the referral center within 12 hours. Four (13 %) patients were brought after 12 hours but within 3 days of the incident. All had deep infection and nonunion at end of 5 months. Those debrided

Trends in Water Use, Energy Consumption, and Carbon Emissions from Irrigation: Role of Shifting Technologies and Energy Sources.

Novel low-pressure irrigation technologies have been widely adopted by farmers, allowing both reduced water and energy use. However, little is known about how the transition from legacy technologies affected water and energy use at the aquifer scale. Here, we examine the widespread adoption of low-energy precision application (LEPA) and related technologies across the Kansas High Plains Aquifer. We combine direct energy consumption and carbon emission estimates with life cycle assessment to calculate the energy and greenhouse gas (GHG) footprints of irrigation. We integrate detailed water use, irrigation type, and pump energy source data with aquifer water level and groundwater chemistry information to produce annual estimates of energy use and carbon emissions from 1994 to 2016. The rapid adoption of LEPA technologies did not slow pumping, but it reduced energy use by 19.2% and GHG emissions by 15.2%. Nevertheless, water level declines have offset energy efficiency gains because of LEPA adoption. Deeper water tables quadrupled the proportion of GHG emissions resulting from direct carbon emissions, offsetting the decarbonization of the regional electrical grid. We show that low-pressure irrigation technology adoption, absent policies that incentivize or mandate reduced water use, ultimately increases the energy and carbon footprints of irrigated agriculture.

SUVDAN FOYDALANISH REJASINI AMALGA OSHIRISH TARTIBLARI, TADBIRLARI HAMDA SUVDAN FOYDALANISH KOEFFITSIENTI

If we look at the existing irrigation methods used today in the country, then they are divided into: ground, rainfall, underground or underground, drip and spray. Basically, they are transferred to the irrigation field in two forms: through gravity and pressure irrigation systems. Naturally, a gravity irrigation system is economically more expensive than a low pressure irrigation system. However, from a performance appraisal stand point, pressure irrigation methods are less efficient and have serious disadvantages

Use of Intravenous Furosemide to Prevent Febrile UTI Following Flexible Ureterorenoscopic Laser Lithotripsy


 
 
 
 Introduction: Flexible ureterorenoscopic laser lithotripsy is the preferred management option for renal stones less than 2 cm. However, flexible ureterorenoscopic laser lithotripsy is not without complications and urinary tract infection is the most common reported complication. Prophylactic antibiotic use, access sheath, low pressure irrigation are few methods to reduce incidence of urinary tract infection. We have studied whether routine use of intravenous furosemide reduces the incidence of febrile urinary tract infection.
 Methods: A total of 70 patients were randomized into two groups where one received intravenous furosemide at the beginning of the procedure and another did not. Flexible ureteroscopic holmium laser lithotripsy was done and patients were followed up for development of febrile urinary tract infection within one week of the procedure.
 Results: 14% of patients who received furosemide and 20% of patients who did not receive developed post- operative febrile urinary tract infection within one week. Two patients in each group had bacteriuria.
 Conclusions: Although the incidence of febrile UTI is lesser with routine use of intravenous furosemide during flexible ureterorensocopic laser lithotripsy, statistical significance could not be proved.
 
 
 

Site Selection of Different Irrigation Systems Using an Analytical Hierarchy Process Integrated with GIS in a Semi-Arid Region

Site selection of different irrigation systems can lead to higher water productivity in drought conditions. The present study intends to evaluate suitable regions along the Izeh plain (Iran) for different pressurized and gravitational irrigation systems using Analytical Hierarchy Process (AHP) based on Geographic Information System (GIS). To that end, a variety of inputs such as climate, topography, skilled labor and system costs, etc. were identified and classified into two main categories of socio-economic and environmental criteria. Each criterion was subdivided into several criteria to make the site selection more specific. A matrix of the pair-wise comparison was, in turn, used to compare these criteria and sub-criteria, and to evaluate them based on their relative importance based on the region’s suitability for different irrigation system alternatives. Geographical layers were then obtained for each sub-criterion to select the most suitable sites for different irrigation systems in the study area. Pressurized irrigation systems including wheel move irrigation system, drip irrigation system and solid-set sprinkler irrigation system, together with gravitational irrigation systems consisting of surface irrigation system, and low-pressure irrigation system were considered as irrigation system alternatives during the site selection process in this study. The result map of site selection for different alternatives showed that surface irrigation, drip irrigation and low pressure systems were the best irrigation system alternatives for the region studied.

Clinical practice in prevention of fracture-related infection: An international survey among 1197 orthopaedic trauma surgeons

IntroductionOpen fractures are still a challenge in orthopaedic trauma surgery, and compared to closed fractures, the rate of complications including fracture-related infection (FRI) remains significantly higher. Although different guidelines on prevention of FRI have been published in past decades, the current recommendations vary significantly. The objectives of this international questionnaire were to evaluate clinical practice procedures for the prevention of FRI in open fractures and to evaluate adherence to available guidelines. MethodsA 17-item questionnaire regarding prophylaxis against infection in fracture care was administered by SurveyMonkey® and was sent via blast e-mail to all users of AOTrauma (Davos, Switzerland). ResultsOverall, 1197 orthopaedic trauma surgeons answered the survey. Although cephalosporins were the most commonly prescribed agents for perioperative antibiotic prophylaxis (PAP) in open fractures, a total of 13 different antibiotics were mentioned in the survey. Furthermore, the duration of PAP was extremely variable with a tendency towards longer treatment periods with increasing open fracture severity. The majority of surgeons (71%) agreed that the optimal duration of PAP was not well defined in the literature. The use of local anti-infective agents varied significantly, although all options received additional votes with increasing injury severity. Some of the other surgical aspects addressed in this review were associated with debridement and irrigation. A delay of six hours from injury to the first debridement was acceptable to 47% of surgeons, but delays were tolerable. Normal saline was the solution used most often for wound irrigation in open fractures (89%), with low-pressure irrigation being applied most commonly (55%). ConclusionsThis international survey provided an overview of clinical practice in FRI prevention, particularly in open fracture cases. The treatment of these serious injuries remains heterogeneous. A major issue is the lack of consensus concerning type and duration of PAP. Furthermore, there seems to be no agreement on the indication for the use of local anti-infective agents. Overall, it is unknown what the repercussions are of this lack of internationally accepted guidelines on daily clinical practice, but it is clear that standardised treatment protocols are preferable in the current medical landscape.

Variable Pulsed Irrigation Algorithm (VPIA) to Reduce Runoff Losses under a Low-Pressure Lateral Move Irrigation Machine

Due to restrictions and limitations on agricultural water worldwide, one of the most effective ways to conserve water in this sector is to reduce the water losses and improve irrigation uniformity. Nowadays, the low-pressure sprinkler has been widely used to replace the high-pressure impact sprinklers in lateral move sprinkler irrigation systems due to its low operating cost and high efficiency. However, the hazard of surface runoff represents the biggest obstacle for low-pressure sprinkler systems. Most researchers have used the pulsing technique to apply variable-rate irrigation to match the crop water needs within a normal application rate that does not produce runoff. This research introduces a variable pulsed irrigation algorithm (VPIA) based on an ON–OFF pulsing technique to conserve irrigation water through (1) decreasing the runoff losses by considering the soil infiltration rate, surface storage capacity, and sprinkler wetting diameter; and (2) ensuring a high level of water distribution uniformity in the direction of machine movement. From a wide range of pulse numbers and widths tested applying a certain water depth to a sandy loam soil, the best solution that gives the lowest runoff and highest uniformity while delivering an acceptable water depth was selected. A MATLAB code was written to simulate the soil infiltration rate, the sprinkler application rate, and to apply the proposed algorithm. The simulation results showed a runoff reduction of at least 90.7% with a high level of distribution uniformity in the direction of movement while delivering the highest possible irrigation depth using the lowest number of pulses.

Primary soft tissue management in open fracture

Debridement of soft tissue and bone in an open fracture situation to minimize infection risk and achieve primary skin closure, or to provide conditions for early soft tissue coverage. Indications are Gustilo-Anderson gradeI-III A-C open fractures. Contraindications are injuries requiring amputation, burns, and life-threatening injuries which make appropriate treatment temporarily impossible. Removal of gross contamination and macroscopic contaminants; debridement of the wound; complete resection of contaminated and dirty tissue; sparse step-by-step resection of contaminated or non-vital wound and bone margins until vital, bleeding tissue begins; low-pressure irrigation with isotonic irrigation fluid; diagnostic biopsies for microbiological testing; reduction of dead space by interpositioning of muscle or cement spacers loaded with local antibiotics; primary wound closure if tension-free closure possible; otherwise, if resources and knowhow permit and satisfactory clean debridement was achieved, local flap; if flap impossible, debridement not satisfactory, secondary tissue necrosis likely, potential remaining contamination or contamination with fecal matter, then vacuum-assisted closure therapy. Wound inspection on the second postoperative day, generous indication for second-look surgery after 36-48 h, wound inspection on the second postoperative day, wound inspection every other day, primary antibiotic prophylaxis with afirst- or second-generation cephalosporin (e. g., cefuroxime), and adaptation of antibiotic therapy according to susceptibility screening. Infection rates of 2-4.7% are reported for immediate primary wound closure in Gustilo-Anderson gradeI, II, and III A open fractures. For Gustilo-Anderson gradeIII B, good wound healing, bony consolidation, and no need for secondary surgery was reported in 86.7% when primary wound closure was achieved.

Flexible ureteroscopic lithotripsy is safe and efficient for renal stone <2 cm accompanied with persistent urinary tract infection

Background and Objective: The aim is to study the efficacy and safety of flexible ureteroscopic lithotripsy (fURSL) for renal stone with persistent urinary tract infection (UTI). Materials and Methods: We retrospectively included 15 cases of patients diagnosed with renal stone together with persistent UTI, who were treated with fURSL from October 2011 to June 2015. A group of 15 patients diagnosed with renal stone, without any sign of persistent UTI, were set as control group. Standard fURSLs were performed by two experienced urologists. Vital signs, routine blood test and kidney, urine, and bladder were observed as well. The double J stent was removed 2–4 weeks after the operation. Results: All operations were done in one-stage. In UTI group, the average operation time was 30 ± 21 min (15–50 min). The stone-free rate (SFR) was 93.3% (14/15). Two cases (13.3%) of fever were observed after the operation, all happened within 6 h postoperatively, with the highest temperature of 39°C. All patients were cured with antibiotics. Conclusions: It is safe to perform fURSL on renal stone patients with persistent UTI under the protection of sensitive antibiotics. The SFR and postoperative complications were acceptable. Low-pressure irrigation and careful postoperative observation are of great importance for these patients.

Assessing low-pressure solid-set sprinkler irrigation in maize

Water and energy are limited and expensive resources. Conserving water and energy is a requirement to ensure the viability of modern pressurized irrigation systems. The objective of this research was to analyze the possibilities of reducing the nozzle operating pressure of impact sprinklers from 300kPa (standard pressure) to 200kPa (low pressure) in solid-set irrigation systems without reducing the sprinkler spacing and maintaining crop yield. Three treatments resulting from combinations of sprinkler type, and working pressure were analyzed: 1) Conventional impact sprinkler operating at 300kPa (CIS300); 2) Conventional impact sprinkler operating at 200kPa (CIS200); and 3) Modified deflecting plate impact sprinkler operating at 200kPa (DPIS200). A randomized experimental design was applied to a maize crop during two seasons (2015 and 2016). Irrigation performance was measured by catch-can monitoring at one replicate of each treatment. Maize growth, yield and its components were measured. Differences between treatments in soil water, maize growth and yield variables were analyzed using ANOVA. Seasonal irrigation uniformity evaluated at the top of the canopy was larger for the standard pressure treatment (93%) than for the low pressure treatments (82% and 84% for DPIS200 and CIS200, respectively). The average wind drift and evaporation losses for the 2016 irrigation season were higher for the CIS300 treatment (17%) than for the low pressure treatments, DPIS200 (15%) and CIS200 (13%). Low pressure treatments did not reduce grain yield compared with the standard pressure treatment. Differences in irrigation performance and maize yield between the low pressure treatments, DPIS200 and CIS200, were not statistically significant. The reduction in energy use by reducing the operating pressure from 300kPa to 200kPa would allow to increase the net farming benefit of individual and collective systems. This is particularly true if low pressure irrigation is considered at the design phase of the irrigation system.

Comparing the speed of irrigation between pulsatile lavage versus gravity irrigation: an Ex-vivo experimental investigation

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.

Pressure Irrigation of Surgical Incisions and Traumatic Wounds.

Pressure irrigation of surgical incisions and traumatic wounds is commonly used to prevent infections. Commercial pressure irrigation devices have proliferated rapidly, but scientific validation of clinical benefit or appropriate use remains uncertain. The published experimental and clinical investigations of pressure irrigation have been reviewed since the introduction of the Waterpik device in 1967 to identify the evidence for use to prevent soft tissue infections associated with injury wounds or surgical incisions. The published literature favors low pressure irrigation between 5-15 pounds/square inch (psi) for experimental removal of bacteria from contaminated tissues, with pressures higher being associated with soft tissue and bone injury. No experimental or clinical data have demonstrated improved benefit from pulsed over continuous lavage. Clinical studies have been very heterogeneous in patient populations and study design; meta-analysis was not feasible. High-risk abdominal operations may have lower surgical site infection rates with pressure irrigation. Pressure irrigation in fractures and joint replacement surgery has shown mixed results. The largest multi-center randomized trial showed no benefit of pulsed (8-10 psi) lavage over conventional continuous gravity irrigation of open fractures. Experimental studies have shown effective removal of bacteria and contamination, but with a potential risk of tissue injury or displacement of contamination deeper into the soft tissues. Rigorous clinical documentation has not validated the optimum flow or pressure characteristics of pressure lavage in clinical practice. There is need for randomized clinical trials to validate pressure lavage in the prevention of infections in soft tissue injuries or high-risk surgical incisions.