Pulsed Lavage Research Articles

Wound Healing Society 2015 update on guidelines for pressure ulcers.

Wound Healing Society 2015 update on guidelines for pressure ulcers.

Kocher forceps assisted pedicle screw insertion as an aid to the trainee spinal surgeon.

Our technique uses instruments available in all arthroplasty sets. Once adequate exposure of the entire cup is achieved, a Sterling punch is used to direct a forceful blow on the metallic shell only (Fig 1). Such action resonates the bearing and deforms the taper, causing loosening of the ceramic. The force must be applied to the metal shell only, and not the bearing, to avoid ceramic shattering. The tip from a pulse lavage gun, with integrated vacuum suction, is then used to create a seal around the periphery of the bearing. The suction creates a vacuum strong enough to pull the bearing out of the shell readily (Fig 2). We use this technique routinely when removing hard bearings from a securely fixed shell.

Posterior mini-incision total hip arthroplasty controls the extent of post-operative formation of heterotopic ossification.

Heterotopic ossification (HO) is the formation of bone at extra-skeletal sites. Reported rates of HO after hip arthroplasty range from 8 to 90 %; however, it is only severe cases that cause problems clinically, such as joint stiffness. The effects of surgical-related controllable intra-operative risk factors for the formation of HO were investigated. Data examined included gender, age of patient, fat depth, length of operation, incision length, prosthetic fixation method, the use of pulsed lavage and canal brush, and component size and material. All cases were performed by the same surgeon using the posterior approach. A total of 510 cases of hip arthroplasty were included, with an overall rate of HO of 10.2 %. Longer-lasting operations resulted in higher grades of HO (p = 0.047). Incisions >10 cm resulted in more widespread HO formation (p = 0.021). No further correlations were seen between HO formation and fat depth, blood loss, instrumentation, fixation methods or prosthesis material. The mini-incision approach is comparable to the standard approach in the aetiology of HO formation, and whilst the rate of HO may not be controllable, a posterior mini-incision approach can limit its extent.

Vertebral Body Lavage before Vertebra/Kyphoplasty Significantly Reduces Cement Leakage in a Clinical Setting

Introduction Vertebra/kyphoplasty is an established treatment option for painful vertebral compression fractures. Cement leakage is the most frequent adverse event for this procedure that can result in serious, sometimes fatal, complications. We have shown in an experimental cadaveric as well as in a large animal model that lavage of the vertebral body before cement injection can remove bone marrow and significantly reduced injection pressure, cement leakage, and pulmonary fat embolism.1,2,3 In this study, we examined the effects of a simplified lavage technique in a clinical setting. Methods Retrospective radiological analysis of cement leakage and distribution of a cohort that underwent lavage before vertebral augmentation; cases without lavage were used as control group. Lavage was performed by rinsing the vertebrae with 100 mL Ringer solution, which was alternatingly injected through one filling cannula while aspirating the bone marrow via the contralateral cannula. For all augmentations, the same cement and filling cannulas were used under identical external conditions. Filling pattern, occurrence of cement leakage as well as type (venous, cortical defect, disc) and extend of the leakage was assessed from biplanar radiographs. Results In a 1-year period (2012–2013) the lavage technique was applied in 138 vertebrae. The control group consisted of 105 vertebrae; patient's characteristics, fracture types, and locations were comparable to the treatment group. The lavage group showed significantly lower leakage rates for the venous and disc type as compared with the standard technique group (venous 12.3 vs. 30.5%, disc 15.9 vs. 60% [both p < 0.001]; cortical defect 10.1 vs. 15.2% [ p = 0.23]). Venous cement extrusions were, in general, shorter after lavage ( p = 0.08) and extrusions larger than 10 mm were only observed in the control group (0 vs. 12.5%). Cement filling pattern (aiming for end plate-to-end plate filling) was significant better in the lavage group ( p = 0.001). According to the multivariate analysis, nonlavaged vertebra have a 3.57 times higher likelihood for a venous leakage than a lavaged one ( p = 0.0009). Discussion The results of this retrospective data analysis show clearly that lavage before vertebra/kyphoplasty can reduce occurrence and severity of cement leakage under clinical condition. The technique is simple and the increase in OR time (range, 10–30 seconds) and costs (< 1$) are insignificant. References Benneker LM, Heini PF, Suhm N, Gisep A. The effect of pulsed jet lavage in vertebroplasty on injection forces of polymethylmethacrylate bone cement, material distribution, and potential fat embolism: a cadaver study. Spine (Phila Pa 1976) 2008;33(23) E906-E910 Boger A, Benneker LM, Krebs J, Boner V, Heini PF, Gisep A. The effect of pulsed jet lavage in vertebroplasty on injection forces of PMMA bone cement: an animal study. Eur Spine J 2009;18(12) 1957-1962 Benneker LM, Krebs J, Boner V, Boger A, Hoerstrup S, Heini PF, Gisep A. Cardiovascular changes after PMMA vertebroplasty in sheep: the effect of bone marrow removal using pulsed jet-lavage. Eur Spine J 2010;19(11) 1913-1920. P070.

Clinical Issues—May 2015

This MonthUpdate on perioperative Ebola precautionsKey words: Ebola, PPE, airborne, droplet, respirator.Contaminated rigid sterilization containersKey words: rigid sterilization containers, filters, valves, latches, gaskets.Requirements for storing autologous tissueKey words: tissue bank, autologous tissue, US Food and Drug Administration, human cells, delayed replantation or autotransplantation.Storing autologous human vein autograftsKey words: autografts, storage media, Tiprotec®, X‐Vivo 10®, American Association of Tissue Banks.Dropped autograftsKey words: autograft, pulse lavage, wound classification, dropped grafts, cranial bone graft.Antimicrobial and fluid barrier fabricsKey words: antimicrobial fabrics, fluid barrier fabrics, surgical site infections, scrub attire, surgical attire.

ACP Guidelines for Preventing, Treating Pressure Ulcers

ACP Guidelines for Preventing, Treating Pressure Ulcers

In Vitro Characterization of Lavage Splash and Effectiveness of Lavage Shield

BACKGROUND: Utilization of fluid to remove debris from surgical wounds has been a standard of medical care for centuries. Electrically powered pulse lavage systems are now regularly used to flush wounds in the operating room. This study aims to characterize splash patterns and contamination generated by different irrigation techniques commonly used in the treatment of surgical wounds.METHODS: 4 different irrigation scenarios: gravity flow (GF), asepto bulb syringe (ABS), high pressure pulsatile lavage without splash shield (HPPL), and high pressure pulsatile lavage with splash shielding (HPPL-S) were conducted on a Sawbone® knee model anchored to a standard operating table in a fully operational operating room of a community hospital. Normal saline supplemented with Fluorescein dye was utilized as the fluid. The OR was divided into 4 quadrants and surveyed with a UV light source to characterize the presence of fluorescent fluid/droplets and radius of droplet displacement.RESULTS: The HPPL trials contaminated the entire room with droplets that were too numerous to count. The HPPL-S trials reduced the number of droplets in quadrants outside of the “head right” quadrants, to a range of 0-12 droplets. In addition, the HPPL-S trial reduced the droplet distance to levels comparable to or below the GF and ABS droplet distance.DISCUSSION: This is the first study to characterize splash patterns seen with different irrigation systems. The addition of an inexpensive splashguard during high-pressure irrigation drastically reduced splash displacement. Decreased splash displacement theoretically reduces OR contamination and the resultant risk of nosocomial contamination.

Clinical experience of morel-lavallee syndrome.

Morel-Lavallee syndrome is closed internal degloving of subcutaneous tissue from the underlying fascia by trauma. It was first described in 1848 by French physician Victor Auguste Francosis Morel-Lavallee [1]. The cavity developed and filled with fluid such as hematoma or liquefied fat etc. It was associated with significant soft tissue injury and frequently occurred on the greater trochanter [2]. Although not common, it can be very severe with infection. The first case was a 70-year-old man who had suffered a cultivator accident. Approximately two weeks later, swelling was observed on the left lateral thigh with fluctuation. Ultrasonography and magnetic resonance imaging (MRI) (Fig. 1) were performed and fluid collection was found. It subsided with debridement and percutaneous tube drainage (PCD) and compressive dressing. The patient was treated about 45 days. The second case was a 53-year-old man who suffered a pedestrian traffic accident. MR imaging showed a pelvic bone fracture and a huge hematoma on both thighs. (Fig. 2) He was transfer to plastic surgery 4 days later from the accident. Fig. 1 Magnetic resonance imaging. Fluid collection (white arrow) was observed on left thighs. Fig. 2 Magnetic resonance imaging. Fluid collection (white arrows) was observed on both thighs. Pseudomonas aeruginosa infection was present on the necrotic tissue and necrosis spread like wildfire throughout the cavity. Massive debridement was performed and skin and soft tissue defects were observed on his lower back, sacral area, both buttocks, and lateral thighs. Surgical dressing was done daily and IV antibiotics were administered. The infection subsided and the defect was covered by split thickness skin graft and a local flap (Fig. 3). He was treated about seven months from the day of the accident. The third case was a 45-year-old man who suffered a fall from a ladder, with fluid collection on both thighs. PCD was attempted on both thighs and the symptoms subsided. However, femoral bursitis remained and was removed by simple excision (Fig. 4). Fig. 3 (A) Skin necrosis after injury. Demarcated large area of necrotic tissue was observed. (B) Local flap and split thickness skin graft. Mild contracture was observed. Fig. 4 Femoral bursitis (withe arrow). He was treated for Morel Lavallee syndrome with percutaneous drainage with compression. He underwent one more operation for removal of the bursitis. First and third cases subsided with percutaneous tube drainage and compressive dressing. But the second case, hard to relieve the infection. In this case, Morel-Lavallee syndrome was detected after infection was spread. We report on three cases of Morel-Lavallee syndrome after severe soft tissue injury. Morel-Lavellee syndrome is uncommon and diagnosis is often delayed. MR imaging is good for assessment of Morel-Lavallee syndrome [3]. Various treatment protocols could be used, such as compressive therapy, sclerosant injection, pulse lavage, and open debridement [4,5]. It could be confuse with recalcitrant bursitis of the knee, soft tissue tumors and lymphocele. Analysis of the protein contents and of the cytology of the liquid is the clue for differential diagnosis with them. We consider that the collected fluid and the cavity increased the severity. Infection is spread through the subcutaneous tissue on the internal cavity, and fluid could be a source of bacterial growth. Therefore, drainage of fluid and removal of the cavity was needed before the infection occurred. For that reason, early detection is important, and knowledge of Morel-Lavallee syndrome and a high index of suspicion are needed.

Preventing and Treating Complications After Hip Arthroscopy.

Although arthroscopic procedures are less invasive than open surgical techniques, arthroscopy is not without complications. Complications of hip “scopes” may include traction-related nerve injuries, fluid extravasation, infection, osteonecrosis, and heterotopic ossification (HO). How to address and avoid these complications are the topics of this month’s “Case Connections” article. In the August 27, 2014 JBJS Case Connector , Uquillas and Youm report on a fifty-one-year-old man who presented with symptoms consistent with right-sided femoroacetabular impingement (FAI). Radiographs revealed mixed cam and pincer impingement, and MRI showed an acetabular labral tear, spurring of the acetabulum and femoral neck, a loose body, and chondral delamination. Surgeons used hip arthroscopy to address these multiple problems. Six months after the procedure, the patient had developed increasing lateral hip pain and tightness. At the eight-month follow-up, he reported a sharp spike in hip pain and showed mild impingement signs. Radiographs revealed HO near the greater trochanter, a finding validated by CT (Fig. 1). MRI revealed inflammation surrounding the area of heterotopic bone. Fig. 1 Three-dimensional CT reconstruction showing heterotopic ossification near the greater trochanter. After a year of ineffective anti-inflammatory medication and physical therapy, interventional radiologists performed an ultrasound-guided pulse lavage (1% lidocaine followed by saline solution) to irrigate and debride the 1.3 × 0.08 × 1.1-cm calcific deposit that had been observed on a preprocedure ultrasound. Dispersion of the deposition was noted during the procedure, which was followed by a steroid/anesthetic injection to provide immediate pain relief and treat inflammation. The …

Ultrasound-Guided Pulse Lavage for Heterotopic Ossification After Prior Hip Arthroscopy: A Case Report.

Femoroacetabular impingement (FAI) is an increasingly recognized form of hip pathology in young patients with hip pain1,2. FAI is most commonly caused by abnormal developmental morphology of the proximal aspect of the femur or the acetabulum. There are numerous other etiologies that produce abnormal contact between the femur and the acetabulum. These include prior femoral neck fracture, prior acetabular or femoral osteotomy, acetabular retroversion, and a slipped capital femoral epiphysis3. Ganz et al. provided three classifications of FAI: cam, pincer, or mixed type4. Cam impingement is characterized by a prominence of the femoral neck that impinges onto the acetabulum, resulting in damage to the labrum. The pincer type is characterized by acetabular overcoverage as the mechanism of impingement on a normal femoral head or neck. The mixed type includes aspects of both. All three types follow a common pathway of abnormal morphology, leading to abnormal contact and, as a result, labrum and cartilage damage. Hip arthroscopy has become a widely used tool to treat FAI5-7. An arthroscopic procedure is a minimally invasive way to treat the causative pathology in cam and pincer-type impingement; it also treats the symptomatic lesion, including labral tears and cartilage damage. Despite its clinical advantages compared with open treatment, hip arthroscopy is associated with complications, including traction nerve injury, extra-abdominal fluid extravasation, osteonecrosis, infection, femoral neck fracture, hip instability, and heterotopic ossification (HO)2,5,6,8-10. Incidence of HO has been reported to range from less than 1% to 6.3% in several series2,5,6,8-10. Strategies for limiting HO have included postoperative nonsteroidal anti-inflammatory drugs (NSAIDs) or …

Seasonal diet composition of juvenile and adult pallid sturgeon,Scaphirhynchus albus(Forbes & Richardson, 1905), in the channelized lower Missouri River

Summary Although habitat alterations and reproductive success are the main contributors to declines of the pallid sturgeon, Scaphirhynchus albus (Forbes & Richardson, 1905) listed in 1990 as federally endangered, disrupted trophic links within diets of pallid sturgeon populations have been hypothesized as partial contributors. The objective of this study was to evaluate pallid sturgeon food habits within a 500 km reach of the lower channelized Missouri River using non-lethal pulsed gastric lavage. Trotlines, gill nets, trammel nets, and benthic otter trawls were used to collect 284 pallid sturgeon, which ranged in fork length from 265 to 1047 mm. Stomach contents of pallid sturgeon included fish (Cyprinidae and Ictaluridae), aquatic insects, copepods, leeches, and mussels. Cyprinids were the most abundant prey item; ictalurids were also of high abundance. Otter trawl catch rates of ictalurids and cyprinids were not spatially correlated to the respective abundances in pallid sturgeon diets; however, the ratio of the average catch rate to the average number of fish per pallid sturgeon indicated preference for cyprinids (1.5 : 1), particularly Macrhybopsis species, relative to ictalurids (7 : 1). Our results support the need for management of native cyprinids, especially Macrhybopsis species, which have been in decline within the entire range of the pallid sturgeon. However, pallid sturgeon are also able to consume ictalurids, a species which has remained in high abundance in the lower Missouri River.

An in vitro comparison of tibial tray cementation using gun pressurization or pulsed lavage

Aseptic loosening of the tibial component remains a limitation to the highly successful procedure of total knee arthroplasty (TKA). Pulsed lavage improves bone cement penetration and interface strength in tibial tray cementation. This study tested whether pressurized cement application with a cement gun can compensate the use of jet lavage for bone surface preparation. Tibial components were implanted in six pairs of cadaveric tibiae. On one side, pulsed lavage of the tibial bone was combined with finger packing of bone cement; on the other side, syringe lavage and gun cementing was used. Cement penetration into the bone was determined from computed tomography scans, and Interface strength was determined by pull-out testing. Cement penetration was greater (p = 0.004) and interface strength was higher (p = 0.028) in the pulsed lavage group. Pressurization of cement by gun application could not compensate for the omission of pulsed lavage. Thus, pulsed lavage should be considered a crucial factor in TKA to improve implant fixation, which cannot be compensated for by cement application technique.

Salvage of Contaminated Osteochondral Allografts

Background: Because chondrocyte viability is imperative for successful osteochondral allograft transplantation, sterilization techniques must provide antimicrobial effects with minimal cartilage toxicity. Chlorhexidine gluconate (CHG) is an effective disinfectant; however, its use with human articular cartilage requires further investigation. Purpose: To determine the maximal chlorhexidine concentration that does not affect chondrocyte viability in allografts and to determine whether this concentration effectively sterilizes contaminated osteoarticular grafts. Study Design: Controlled laboratory study. Methods: Osteochondral plugs were subjected to pulse lavage with 1-L solutions of 0.002%, 0.01%, 0.05%, and 0.25% CHG and cultured for 0, 1, 2, and 7 days in media of 10% fetal bovine serum and antibiotics. Chondrocyte viability was determined via LIVE/DEAD Viability Assay. Plugs were contaminated with Staphylococcus aureus and randomized to 4 treatment groups. One group was not contaminated; the 3 others were contaminated and received no treatment, saline pulse lavage, or saline pulse lavage with 0.002% CHG. Serial dilutions were plated and colony-forming units assessed. Results: The control group and the 0.002% CHG group showed similar cell viability, ranging from 67% ± 4% to 81% ± 22% (mean ± SD) at all time points. In the 0.01% CHG group, cell viability was reduced in comparison with control by 2-fold at day 2 and remained until day 7 (P < .01). The 0.05% and 0.25% CHG groups showed a 2-fold reduction in cell viability at day 1 (P < .01). At day 7, cell viability was reduced to 15% ± 18% (4-fold decrease) for the 0.05% CHG group and 10% ± 19% (6-fold decrease) for the 0.25% CHG group (P < .01). Contaminated grafts treated with 0.002% CHG demonstrated no colony-forming units. Conclusion: Pulse lavage with 0.002% CHG does not cause significant cell death within 7 days after exposure, while CHG at concentrations >0.002% significantly decreases chondrocyte viability within 1 to 2 days after exposure and should therefore not be used for disinfection of osteochondral allograft. Pulse lavage does not affect chondrocyte viability but cannot be used in isolation to sterilize contaminated fragments. Overall, 0.002% CHG was shown to effectively decontaminate osteoarticular fragments. Clinical Relevance: This study offers a scientific protocol for sterilizing osteochondral fragments that does not adversely affect cartilage viability.

Simple Steps to Minimize Spine Infections in Adolescent Idiopathic Scoliosis

To examine the surgical site infection (SSI) rates in patients undergoing posterior spinal fusion surgery for adolescent idiopathic scoliosis (AIS) after implementation of a change in antibiotic prophylaxis and intraoperative irrigation. A retrospective review of all consecutive spinal fusions for AIS from 1996 to 2008 was performed. In 2003, 2 changes in our protocol were implemented: (1) routine antibiotic prophylaxis was changed from cefazolin alone to vancomycin and ceftazidime; (2) intraoperative irrigation technique was changed from bulb syringe to pulse lavage irrigation. We compared the rates of deep SSI requiring irrigation and debridement before institution of these changes (1996 to 2002) to the rates after these changes (2003 to 2008). Before the change in the antibiotic and lavage regimen, 261 spinal fusions were performed. Of these, 28/261 (11%) patients underwent irrigation and debridement for SSI. The most common infecting pathogen was coagulase-negative Staphylococcus aureus (47%). Between the years 2003 and 2008, 263 spinal fusions were performed. Only 2/263 (0.7%) patients underwent irrigation and debridement for SSI. This decrease in infection rate is highly significant (P<0.001). Routine use of vancomycin and ceftazidime and pulsatile lavage for posterior spinal fusion in AIS patients decreased the rates of postoperative infection by 10 fold. As 2 variables were changed, it is impossible to know the relative effect of each. However, as spine infections can be so devastating, and the potential risks of these changes are small, we recommend both the new antibiotic and irrigation protocol. Level III.

Irrigation and Debridement

Irrigation and Debridement

Pulse Lavage is Inadequate at Removal of Biofilm from the Surface of Total Knee Arthroplasty Materials

In acute periprosthetic infection, irrigation and debridement with component retention has a high failure rate in some studies. We hypothesize that pulse lavage irrigation is ineffective at removing biofilm from total knee arthroplasty (TKA) components. Staphylococcus aureus biofilm mass and location was directly visualized on arthroplasty materials with a photon collection camera and laser scanning confocal microscopy. There was a substantial reduction in biofilm signal intensity, but the reduction was less than a ten-fold decrease. This suggests that irrigation needs to be further improved for the removal of biofilm mass below the necessary bioburden level to prevent recurrence of acute infection in total knee arthroplasty.

Science supporting negative pressure wound therapy with instillation

A new method (V.A.C.ULTA Therapy System, KCI USA, Inc., San Antonio, TX) combines the benefits of negative pressure wound therapy (NPWT; V.A.C. Therapy, KCI USA, Inc.) with regulated, periodic instillation of user-selected topical wound solutions (V.A.C. VeraFlo Therapy, KCI USA, Inc.). In simulated wound model studies comparing solution distribution using NPWT with and without a soak phase, the instillation soak phase allowed for uniform solution distribution across the wound bed, whereas continuous (no soak) irrigation resulted in uneven coverage. Additional in vitro work illustrated that bacterial particle aerosolisation during wound cleansing was significantly decreased using NPWT with instillation (NPWTi) versus commercially available low-pressure wound cleansers (P < 0·05). In porcine studies, NPWT with saline instillation induced 43% more granulation tissue versus NPWT (P < 0·05) and was as effective at wound cleansing as pulsed lavage. These studies have demonstrated that NPWTi may be an effective wound management therapy that provides both wound cleansing and NPWT benefits.

The Protective Effect of Pulsed Lavage Against Implant Subsidence and Micromotion for Cemented Tibial Unicompartmental Knee Components: An Experimental Cadaver Study

Cemented UKAs were performed in 12 pairs of human cadaver legs and the bone bed was cleansed using pulsed lavage (group A) and conventional syringe lavage (group B). Subsidence and micromotion of the loaded tibial trays were measured. There was a significant effect of BMD on subsidence (P=0.043) but not on micromotion. Cement penetration of group A was significantly increased (P=0.005). Group A showed a reduced implant subsidence (P=0.025) and micromotion (P=0.026) compared to group B. The group differences in micromotion and implant subsidence of UKA tibial components were statistically significant but rather small and might clinically be of minor importance. Nevertheless a worse bone quality adversely affected implant subsidence and pulsed lavage had a protective effect in these specimens.

Pressurized Pulse Irrigation with Saline Reduces Surgical‐site Infections following Major Hepatobiliary and Pancreatic Surgery: Randomized Controlled Trial

Surgical site infections (SSI) are a significant cause of postoperative morbidity. Pressurized pulse irrigation of subcutaneous tissues may lower infection rates by aiding in the debridement of necrotic tissue and reducing bacterial counts compared to simply pouring saline into the wound. A total of 128 patients undergoing laparotomy extending beyond 2 h were randomized to treatment of wounds by pressurized pulse lavage irrigation (<15 psi) with 2 L normal saline (pulse irrigation group), or to standard irrigation with 2 L normal saline poured into the wound, immediately prior to skin closure (standard group). Only elective cases were included, and all cases were performed within a specialized hepatobiliary and pancreatic surgery unit. There were 62 patients managed by standard irrigation and 68 were managed by pulse irrigation. The groups were comparable in most aspects. Overall there were 16 (13 %) SSI. Significantly fewer SSI occurred in the pulse irrigation group [4 (6 %) vs. 12 (19 %); p = 0.032]. On multivariate analysis, the use of pulse irrigation was the only factor associated with a reduction in SSI with an odds ratio (OR) of 0.3 [95 % confidence interval (95 % CI) 0.1-0.8; p = 0.031]. In contrast, hospital length of stay of greater than 14 days was associated with increased infections with an OR of 7.6 (95 % CI 2.4-24.9; p = 0.001). Pulse irrigation of laparotomy wounds in operations exceeding 2 h duration reduced SSI after major hepatobiliary pancreatic surgery. (Australian New Zealand Clinical Trials Registry, ACTRN12612000170820).

Management of vascular trauma from dog bites

Vascular trauma from large-dog bites present with a combination of crush and lacerating injuries to the vessel, as well as significant adjacent soft tissue injury and a high potential for wound complications. This retrospective case series evaluates our 15 years of experience in managing this uncommonly seen injury into suggested treatment recommendations. From our database, 371 adult patients presented with dog bites between July 1997 and June 2012. Twenty (5.4%) of those patients had vascular injuries requiring surgical intervention. Patient demographics, anatomic location of injury, clinical presentation, imaging modality, method of repair, and complication rates were reviewed to assess efficacy in preserving limb function. Pediatric patients were managed at the regional children's hospital and, therefore, not included in this study. Among the 20 surgically treated vascular injuries, there were 13 arterial-only injuries, two venous-only injuries, and five combination arterial and venous injuries. Seventeen patients (85%) had upper extremity injuries; three patients had lower extremity injuries (15%). The axillobrachial artery was the most commonly injured single vessel (n = 9/20; 45%), followed by the radial artery (n = 4/20; 20%). Surgical repair of vascular injuries consisted of resection and primary anastomosis (four), interposition bypass of artery with autogenous vein (13), and ligation (two), with (one) being a combination of bypass and ligation. All patients had debridement of devitalized tissue combined with pulse lavage irrigation and perioperative antibiotics. Associated injuries requiring repair included muscle and skin (n = 10/20; 50%), bone (n = 1/20; 5%), nerve (n = 1/20; 5%), and combinations of the three (n = 5/20; 25%). Postoperative antibiotic therapy was administered for 14.7 ± 8.2 days in all 20 patients. Four patients (20%) developed postoperative wound infections, although this did not compromise their vascular repair. Of the patients compliant with postoperative surveillance, all limbs (100%) were viable at discharge and at 1-year follow-up. Dog bite vascular injuries are an uncommon occurrence, where extremity pulse abnormalities are the most common presentation. These injuries are also associated with significant adjacent soft tissue trauma, which warrants aggressive debridement and perioperative antibiotic therapy. Despite vigilant management, nearly one-fifth of our patients sustained wound infections. All infections were successfully managed with broad-spectrum antibiotics, and all limbs were preserved 1-year postoperatively.