Fluid lavage in patients with open fracture wounds (FLOW): an international survey of 984 surgeons.
BACKGROUND
Although surgeons acknowledge the importance of irrigating open fracture wounds, the choice of irrigating fluid and delivery pressure remains controversial. Our objective was to clarify current opinion with regard to the irrigation of open fracture wounds.


METHODS
We used a cross-sectional survey and a sample-to-redundancy strategy to examine surgeons' preferences in the initial management of open fracture wounds. We mailed this survey to members of the Canadian Orthopaedic Association and delivered it to attendees of an international fracture course (AO, Davos, Switzerland).


RESULTS
Of the 1,764 surgeons who received the questionnaire, 984 (55.8%) responded. In the management of open wounds, the majority of surgeons surveyed, 676 (70.5%), favoured normal saline alone. Bacitracin solution was used routinely by only 161 surgeons (16.8%). The majority of surgeons, 695 (71%) used low pressures when delivering the irrigating solution to the wound. There was, however considerable variation in what pressures constituted high versus low pressure lavage. The overwhelming majority of surgeons, 889 (94.2%), reported they would change their practice if a large randomized controlled trial showed a clear benefit of an irrigating solution - especially if it was different from the solution they used.


CONCLUSIONS
The majority of surgeons favour both normal saline and low pressure lavage for the initial management of open fracture wounds. However, opinions varied as regards the comparative efficacy of different solutions, the use of additives and high versus low pressure. Surgeons have expressed considerable support for a trial evaluating both irrigating solutions and pressures.
Petrisor
Brad
B
Department of Surgery, McMaster University, Hamilton, Ontario, Canada. petrisor@Hhsc.ca
Jeray
Kyle
K
Schemitsch
Emil
E
Hanson
Beate
B
Sprague
Sheila
S
Sanders
David
D
Bhandari
Mohit
M
D000328:Adult; D000891:Anti-Infective Agents, Local / Q000627:therapeutic use*; D001414:Bacitracin / Q000627:therapeutic use; D002710:Chlorhexidine / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D005597:Fractures, Open / Q000628:therapy*; D019538:Health Care Surveys; D006801:Humans; D006861:Hydrogen Peroxide / Q000627:therapeutic use; D017613:Iodine Compounds / Q000627:therapeutic use; D008875:Middle Aged; D009985:Orthopedics / Q000379:methods*; D010818:Practice Patterns, Physicians'; D011312:Pressure; D016032:Randomized Controlled Trials as Topic; D012107:Research Design; D012915:Soaps / Q000627:therapeutic use; D012965:Sodium Chloride / Q000627:therapeutic use*; D011795:Surveys and Questionnaires; D007507:Therapeutic Irrigation / Q000379:methods*
D000891:Anti-Infective Agents, Local; D017613:Iodine Compounds; D012915:Soaps; D001414:Bacitracin; D012965:Sodium Chloride; D006861:Hydrogen Peroxide; D002710:Chlorhexidine