Title: Early Wound Irrigation Improves the Ability to Remove Bacteria
Authors: Brett D. Owens, MD and Joseph C. Wenke, PhD
Source: Journal of Bone and Joint Surgery (American). 2007; 89-A: 1723-26.
PODIATRIC RELEVANCE:
Contaminated wounds are commonly treated by foot and ankle surgeons. Although it is generally accepted that a reduction in the bioburden of a contaminated wound by irrigation is beneficial, there is a paucity of prospective evidence demonstrating that early wound irrigation improves the ability to remove bacteria.
METHODS:
In this prospective study, an established large-animal contaminated extremity model was used to evaluate the effect of irrigation timing on bacterial removal. A reproducible complex musculoskeletal wound was created in the leg of thirty goats. All wounds were inoculated with a genetically altered, photon emitting Pseudomonas aeruginosa (lux), and then closed primarily. At three, six and twelve hours after surgery and inoculation, the animals were killed and the wounds evaluated for bacterial load with a photon-counting camera before and after pulsatile irrigation with 6 L of saline solution.
RESULTS:
Earlier wound irrigation resulted in statistically significant superior bacterial removal in this model. Irrigation at three hours resulted in a 70%+/-2% reduction in bacterial counts from the pre-irrigation level. Only 52%+/-3% and 37+/-4% of the bacteria was removed at six and twelve hours, respectively. The differences in bacterial reduction between three and six hours (p=0.0004), three and twelve hours (p<0.0001), and six and twelve hours (p=0.0039) were all statistically significant.
COMMENTS:
This prospective animal model demonstrated a statistically significant reduction in the bacterial bioburden with early wound irrigation. While the actual bacterial counts necessary to establish a wound infection in humans is not totally clear, early irrigation of the contaminated wound is recommended for the prevention of infection.
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Disclaimer:
Scientific Abstract Monthly postings are submitted by podiatric surgical residents. The ideas presented are not the opinions of the American College of Foot and Ankle Surgeons (ACFAS), nor are they presented as facts. ACFAS presents this information without any warranty of any kind, expressed or implied, and is not liable for its accuracy nor for any loss or damage caused by the user's reliance on information obtained in these areas.