Irrigation in facial and scalp lacerations: does it alter outcome?
OBJECTIVE
Animal and human studies suggest that irrigation lowers the infection rate in contaminated wounds, but there is no evidence that this common practice is beneficial for "clean" lacerations. We tested the null hypothesis that there is no difference in the infection rate for noncontaminated lacerations to the face and scalp that are irrigated before primary closure compared with similar wounds that are closed primarily without irrigation.


METHODS
We performed a cross-sectional study of consecutive patients presenting to a suburban, academic emergency department between October 1992 and August 1996. Patients with nonbite, noncontaminated facial skin or scalp lacerations who presented less than 6 hours after injury were included. Structured, closed-question data collection instruments were completed at the time of laceration repair and at suture removal. The primary outcome parameters were the incidence of wound infection and the short-term cosmetic appearance of lacerations in patients who did or did not receive irrigation.


RESULTS
A total of 1,923 patients were included in the study group; 1,090 patients received saline irrigation, and 833 patients did not. The irrigation and nonirrigation groups were similar with regard to time from injury to presentation (1.56 versus 1.42 hours, respectively), frequency of linear wound morphology (82% versus 88%), frequency of smooth wound margins (72% versus 82%), number of layers of closure (1.14 versus 1.26), number of skin sutures applied (4.98 versus 4.65), number of deep sutures applied (.70 versus 1.05), and use of oral antibiotic prophylaxis (2.8% versus 4.0%). With respect to outcomes, the incidence of wound infection was not significantly different between the two treatment groups (.9% versus 1.4%, respectively; P = .28). Likewise, the percentage of patients who had an "optimal" cosmetic appearance was similar in the two groups (75.9% versus 81.7%, respectively; P = .07).


CONCLUSIONS
Irrigation before primary closure did not significantly alter the rate of infection or the cosmetic appearance in our study population with clean, noncontaminated facial and scalp lacerations.
Hollander
J E
JE
Department of Emergency Medicine, University Medical Center, State University of New York at Stony Brook, USA. jholland@mail.upenn.edu
Richman
P B
PB
Werblud
M
M
Miller
T
T
Huggler
J
J
Singer
A J
AJ
D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D006259:Craniocerebral Trauma / Q000145:classification / Q000628:therapy*; D003430:Cross-Sectional Studies; D004638:Emergency Treatment; D005151:Facial Injuries / Q000145:classification / Q000628:therapy*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D012965:Sodium Chloride / Q000627:therapeutic use; D013537:Sutures; D007507:Therapeutic Irrigation; D016896:Treatment Outcome; D014945:Wound Healing; D014946:Wound Infection / Q000453:epidemiology / Q000517:prevention & control*
D000900:Anti-Bacterial Agents; D012965:Sodium Chloride