title: High and low pressure irrigation in contaminated wounds with exposed bone.
abstract: BACKGROUND
  Irrigation and debridement are essential in the initial management of traumatic wounds. The relative efficicacy of low pressure irrigation compared with high pressure irrigation remains unclear.
  
  
  OBJECTIVE
  The purpose of this study was to examine the time dependent efficacy of both high and low pressure lavage in removing adherent bacteria from traumatic wounds with exposed bone.
  
  
  METHODS
  Using an in-vivo model, we created bilateral Staphylococcus aureus contaminated femoral wounds in 30 mice. The wounds were incubated for 1 to 10 hours and lavaged with either high (70 psi) or low pressure lavage (1-2 psi). The mean colony forming units of bacteria were compared between groups at each time point.
  
  
  RESULTS
  High and low pressure lavage were effective in removing adherent bacteria from contaminated wounds up to 8 hours and 4 hours, respectively. High pressure lavage was more effective than low pressure at every time point.
  
  
  CONCLUSIONS
  The efficacy of low pressure lavage in wounds with exposed bone is questionable when irrigation is delayed beyond 4 hours.
authors.affiliation: Hamilton Civic Hospitals Research Centre, McMaster University Hamilton, Ontario, Canada. bhandari@netinc.ca
authors.forename: M
authors.initials: M
authors.lastname: Bhandari
authors.forename: K
authors.initials: K
authors.lastname: Thompson
authors.forename: A
authors.initials: A
authors.lastname: Adili
authors.forename: S G
authors.initials: SG
authors.lastname: Shaughnessy
mesh_terms: D000818:Animals; D015169:Colony Count, Microbial; D004195:Disease Models, Animal; D005269:Femur / Q000382:microbiology*; D051379:Mice; D011312:Pressure; D013203:Staphylococcal Infections / Q000209:etiology / Q000628:therapy*; D013211:Staphylococcus aureus / Q000254:growth & development*; D007507:Therapeutic Irrigation / Q000379:methods*; D014946:Wound Infection / Q000209:etiology / Q000382:microbiology / Q000628:therapy*; D014950:Wounds, Penetrating / Q000150:complications*