Journal Article

A Trial of Wound Irrigation in the Initial Management of Open Fracture Wounds

Anglen, Jeff, Walter, Stephen, Jones, Clifford, Schemitsch, Emil H, Sprague, Sheila, Tanner, Stephanie L, Stone, Trevor B, Kreder, Hans, Guyatt, Gordon H, Papp, Steven, Petrisor, Brad A, Sancheti, Parag, Bhandari, Mohit, Sun, Xin, Tornetta, 3rd, Paul, Heels-Ansdell, Diane, Della Rocca, Gregory J, Jeray, Kyle J, McKay, Paula, Devereaux, P J, Liew, Susan, Tufescu, Ted

2015

Overview

This study investigated castile soap versus normal saline irrigation delivered by means of high, low, or very low pressure for open fractures. Reoperation rates were similar, regardless of irrigation pressure; the rate was higher in the soap group than in the saline group. The initial management of open fractures requires thorough irrigation and débridement 1 – 4 to prevent infection and promote wound and bone healing. 2 , 4 Clinicians accomplish débridement by removing all visible debris and necrotic tissue and by providing copious irrigation of the wound. Controversy exists regarding the choice of irrigation pressure and solution. 4 – 13 High pressure may be more effective than low pressure in removing particulate matter and bacteria 7 – 10 but at the expense of bone damage 8 , 11 and a resultant delay in bone healing. 12 Low pressure may avoid bone damage and delayed healing but at the possible cost of less effective . . .

• Publisher: Massachusetts Medical Society
• Subject: Adult / Bone healing / Bone surgery / Contaminants / Female / Follow-Up Studies / Fractures / Fractures, Open - surgery / Fractures, Open - therapy / Humans / Kaplan-Meier Estimate / Male / Medical treatment / Middle Aged / Patients / Pressure / Reoperation / Single-Blind Method / Soaps - therapeutic use / Sodium Chloride - therapeutic use / Therapeutic Irrigation - methods / Wound Healing / Wound infection / Wound Infection - prevention & control / Wound Infection - surgery