Comparison of Bulb Syringe and Pulsed Lavage Irrigation with Use of a Bioluminescent Musculoskeletal Wound Model

Svoboda, Major Steven J.; Bice, Terry G.; Gooden, Heather A.; Brooks, Daniel E.; Thomas, Darryl B.; Wenke, Joseph C.

doi:10.2106/jbjs.e.00248

Cited by 58 publications

(67 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…PL also resulted in the same quantitative drop of bacteria numbers with 3 l of irrigant that was achieved in 9 l using the bulb system. The authors concluded that PL was a more effective and efficient method of irrigation to remove bacteria than a conventional irrigation technique [90].…”

Section: Infection In Conflict Wounded-future Directions In Research mentioning

confidence: 99%

Infection in conflict wounded

Eardley

Brown

Bonner

et al. 2011

Phil. Trans. R. Soc. B

View full text Add to dashboard Cite

Although mechanisms of modern military wounding may be distinct from those of ancient conflicts, the infectious sequelae of ballistic trauma and the evolving microbial flora of war wounds remain a considerable burden on both the injured combatant and their deployed medical systems. Battlefield surgeons of ancient times favoured suppuration in war wounding and as such Galenic encouragement of pus formation would hinder progress in wound care for centuries. Napoleonic surgeons eventually abandoned this mantra, embracing radical surgical intervention, primarily by amputation, to prevent infection. Later, microscopy enabled identification of microorganisms and characterization of wound flora. Concurrent advances in sanitation and evacuation enabled improved outcomes and establishment of modern military medical systems. Advances in medical doctrine and technology afford those injured in current conflicts with increasing survivability through rapid evacuation, sophisticated resuscitation and timely surgical intervention. Infectious complications in those that do survive, however, are a major concern. Addressing antibiotic use, nosocomial transmission and infectious sequelae are a current clinical management and research priority and will remain so in an era characterized by a massive burden of combat extremity injury. This paper provides a review of infection in combat wounding from a historical setting through to the modern evidence base.

show abstract

Section: Infection In Conflict Wounded-future Directions In Research mentioning

confidence: 99%

Infection in conflict wounded

Eardley

Brown

Bonner

et al. 2011

Phil. Trans. R. Soc. B

View full text Add to dashboard Cite

show abstract

“…At 1,4,8,12,24,36,48,72,96,120, and 144 h, pellets were removed, oven dried at 378C for 1 h, and weighed. The pellets were then reimmersed in fresh DI water.…”

Section: Dissolution Testingmentioning

confidence: 99%

“…3) in 20 ml phosphate buffered saline (PBS) in a 378C water bath. At 1,4,8,12,24,36,48,72,96,120,144,168, and 240 h, aliquots were removed and frozen at À408C. At each time point, the pellets were removed and placed in 20 ml fresh PBS.…”

Section: Elution Testingmentioning

confidence: 99%

“…1 To decrease the potential for wound infection, the current standard of care involves removal of all foreign material and necrotic tissue followed by irrigation and systemic antibiotic therapy. [2][3][4] High concentrations of systemic antibiotic are required to attain sufficient local levels in contaminated tissues with compromised vascularization. In the most difficult cases, multiple debridements and prolonged antibiotic therapy are required over several weeks to complete treatment.…”

mentioning

confidence: 99%

“…In the most difficult cases, multiple debridements and prolonged antibiotic therapy are required over several weeks to complete treatment. 4,5 Antibiotic toxicity, side effects, and evolution of bacterial resistance are problems associated with this course of therapy. 5,6 Local delivery systems that place antibiotics directly at the contamination site are favorable alternatives or adjuncts because they minimize systemic toxicity and eliminate concerns about antibiotic penetration.…”

mentioning

confidence: 99%

See 2 more Smart Citations

Preliminary in vitro evaluation of an adjunctive therapy for extremity wound infection reduction: Rapidly resorbing local antibiotic delivery

Jackson

Richelsoph

Courtney

et al. 2008

Journal Orthopaedic Research

View full text Add to dashboard Cite

Despite the continuing advances in treatment of open fractures and musculoskeletal wounds, infection remains a serious complication. Current treatments to prevent infection utilize surgical debridement and irrigation, and high doses of systemic antimicrobial therapy. The aim of this work was to evaluate, in vitro, the potential of a fast-resorbing calcium sulfate pellet loaded with an antibiotic. The pellet could be used as an adjunctive therapy at the time of debridement and irrigation to reduce bacterial wound contamination. Small pellets containing a binder and calcium sulfate were engineered to resorb rapidly (within 24 h) and deliver high local doses of antibiotic (amikacin, gentamicin, or vancomycin) to the wound site while minimizing systemic effects. Results from dissolution, elution, and biological activity tests against P. aeruginosa and S. aureus were used to compare the performance of antibiotic-loaded, rapidly resorbing calcium sulfate pellets to antibiotic-loaded crushed conventional calcium sulfate pellets. Antibiotic-loaded rapidly resorbing pellets dissolved in vitro in deionized water in 12-16 h and released therapeutic antibiotic levels in phosphate buffered saline that were above the minimal inhibitory concentration for P. aeruginosa and S. aureus, completely inhibiting the growth of these bacteria for the life of the pellet. Crushed conventional calcium sulfate pellets dissolved over 4-6 days, but the eluates only contained sufficient antibiotic to inhibit growth for the first 4 h. These data indicate that fast-resorbing pellets can release antibiotics rapidly and at therapeutic levels. Adjunctive therapy with fast-acting pellets is promising and warrants further in vivo studies. ß

show abstract