Traumatic wound debridement: a comparison of irrigation methods.
OBJECTIVE
To test wound debridement efficacy and soft tissue damage produced by high-pressure pulsatile lavage (HPPL), suction irrigation, and bulb syringe irrigation.


METHODS
Randomized trial in an in vitro model.


METHODS
Medical school orthopaedic department.


METHODS
No patients were used in this study.


METHODS
Beef flank steaks (100-g +/- 10-g) were divided into 8 test groups and incised uniformly. Four test groups were contaminated with 2 g of rock dust and 4 were not. The specimens were then treated as follows: nothing (control), bulb irrigation, suction irrigation, or HPPL.


METHODS
Runoff from the irrigation was collected, filtered, lyophilized, and ashed to allow for quantitative determination of organic and inorganic material removed from the wound by each irrigation method. Digital photographs of the tissue samples were subjected to blinded grading on a scale of 1 to 5 to assess macroscopic soft tissue damage.


RESULTS
Qualitatively, tissue samples treated with HPPL consistently received worse grades for tissue damage than samples in any other experimental group. Quantitative soft tissue damage analysis revealed that significantly more organic material was removed from samples treated with HPPL (141.3 +/- 58.9 mg) than those treated with bulb syringe (50.7 +/- 28.6 mg) or suction irrigation (108.7 +/- 174.5 mg). Surprisingly, significantly less inorganic contaminant was removed from tissue samples treated with HPPL (1549.6 +/- 77.3 mg) than those treated with bulb syringe (1834.9 +/- 39.1 mg) or suction irrigation (1827 +/- 39.4 mg).


CONCLUSIONS
There has been some concern regarding damage produced by HPPL. According to our quantitative soft tissue damage data, tissue treated by HPPL was damaged significantly more than tissue treated with bulb syringe or suction irrigation. Our qualitative tissue damage grade data showed that HPPL treated test groups appeared more damaged than other irrigation groups. Surprisingly, HPPL removed significantly less inorganic contaminant than other debridement methods, and it is proposed that HPPL may drive some contaminants deeper into the tissue rather than removing them. This study seems to support the concept that suction and sharp debridement, as practiced by most surgeons, may remove foreign bodies well without the use of HPPL.
Draeger
Reid W
RW
Department of Orthopaedics, University of North Carolina, Chapel Hill, NC 27599-7055, USA.
Dahners
Laurence E
LE
D000818:Animals; D002417:Cattle; D003646:Debridement / Q000379:methods*; D005547:Foreign Bodies / Q000628:therapy*; D066298:In Vitro Techniques; D018482:Muscle, Skeletal / Q000293:injuries*; D011312:Pressure / Q000009:adverse effects; D013594:Syringes; D007507:Therapeutic Irrigation / Q000295:instrumentation*; D014947:Wounds and Injuries / Q000628:therapy*