Concepts in wound irrigation of open fractures: ‘Where we came from, and where are we now?

Gupta, Ravi; Sharma, Atul; Singhal, Akash; Shail, Sumukh; Masih, Gladson David

doi:10.1016/j.jcot.2021.101638

Cited by 6 publications

(4 citation statements)

References 57 publications

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“…But, to the best of our knowledge, there are no data available whether bacteria that are propagated up to 2.2 mm into muscle tissue lead to more infections of deeper structures. Latest reviews have doubted that high-pressure pulsatile lavage irrigation is able to increase the effectiveness of cleaning traumatic wounds in open fractures [29,30]. Also, high pressure was not more effective than lowpressure irrigation in cleaning a contaminated wound in an experimental rat model [31].…”

Section: Discussionmentioning

confidence: 99%

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Pulsatile lavage systems and their potential to penetrate soft tissue

Knappe

Lunz

Bülhoff

et al. 2022

Eur J Trauma Emerg Surg

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Background In orthopedic and trauma surgery, pulsatile lavage systems are used to clean soft tissue. This may be necessary in septic surgeries or in case of contaminated wounds after trauma. Positive features such as reduction of bacterial contamination and removal of foreign particles are counterbalanced by negative aspects such as bacterial seeding in deeper tissue layers, damage to various tissues and even cases of air embolism. Purpose The aim of this prospective experimental in vitro study was to compare impact pressure and flow rate in three different pulsatile lavage systems and to determine, whether these parameters alter their ability to reach deeper soft tissue layers. Methods To test the penetration of soft tissue, the muscle tissue was flushed with contrast medium instead of saline fluid and afterwards scanned by computed tomography. Results Impact pressure and flow rate showed significant differences between the different systems. There were no significant differences between the three devices in terms of total penetration volume, but there were significant differences in penetration depth. Conclusion In this study, we found that higher impact pressure leads to deeper penetration and therefore bacteria are likely to be transferred to deeper tissue layers.

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Section: Discussionmentioning

confidence: 99%

“…Latest reviews have doubted that high-pressure pulsatile lavage irrigation is able to increase the effectiveness of cleaning traumatic wounds in open fractures [ 29 , 30 ]. Also, high pressure was not more effective than low-pressure irrigation in cleaning a contaminated wound in an experimental rat model [ 31 ].…”

Section: Discussionmentioning

confidence: 99%

Pulsatile lavage systems and their potential to penetrate soft tissue

Knappe

Lunz

Bülhoff

et al. 2022

Eur J Trauma Emerg Surg

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“…If the wound is left open, it should be dressed with sterile saline-soaked gauze, a synthetic dressing, a VAC system or an antibiotic dressing. Serial debridement(s) may be performed every 24 h to 48 h, depending on the case, until there is no necrotic soft tissue or bone, and then primary or secondary deferred closure should be performed (2,16).…”

Section: Gustilo and Anderson Classification Of Open Fracturesmentioning

confidence: 99%

Panoramic Review of Open Fractures, Description, Epidemiology, Assessment, Classification, Treatment and Complications

Bryam Esteban Coello García,

Miguel Sebastián Jiménez Jiménez,

Víctor Daniel Camacho Iza

et al. 2023

EPRA

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Introduction: An open or exposed fracture is a fracture that has communication with the external environment through a skin wound. Usually these types of severe fractures require treatment by the orthopedic and plastic surgery team to address both bone and soft tissue injuries. Objective: to detail current information related to open fractures, description, epidemiology, evaluation, classification, treatment and complications. Methodology: a total of 33 articles were analyzed in this review, including review and original articles, as well as clinical cases, of which 20 bibliographies were used because the other articles were not relevant to this study. The sources of information were PubMed, Google Scholar and Cochrane; the terms used to search for information in Spanish, Portuguese and English were: exposed fractures, open fractures, acute trauma, compartment syndrome, vascular injury, debridement. Results: the general average age of onset is 45.5 years, the incidence decreases in men and increases in women with age. Automobile accidents are the most common cause of open fractures of the lower limbs, accounting for approximately 34.1% of these injuries. The highest incidence of open fractures in males is between 15 and 19 years, the highest incidence in females is between 80 and 89 years. Conclusions: Knowledge of the management of open fractures is of vital importance, due to the fact that this type of fracture presents a high risk of infections, as well as other types of complications. The initial approach to the injured individual with an open fracture should be based on the principles of Advanced Trauma Life Support (ATLS). Clinical and imaging evaluation is important in this type of fracture, as well as recognizing the value of the classification systems that play a critical role when treating surgically. Irrigation and debridement remain the gold standards for proper wound management. The most important point in the treatment of an open fracture is proper lavage and debridement. KEY WORDS: trauma, open fractures, bone exposure, treatment.

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“…However, a giving set with several litres of normal saline and a bowl using low-pressure pulsatile lavage is typically adequate. Normal saline remains the standard irrigation solution as it is non-tissue toxic and has the same tonicity as body fluids (Gupta et al., 2021). Irrigation of open fracture wounds with antibiotic solution offers no advantages and it may increase the risk of wound-healing problems (Anglen, 2005).…”

Section: Surgical Considerations: a Stepwise Approachmentioning

confidence: 99%

Management of conflict injuries to the upper limb. Part 1: assessment and early surgical care

Brown

Roberts

Wordsworth

et al. 2022

J Hand Surg Eur Vol

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Upper limb injuries are common in conflict zones. The functions of the upper limb are impossible to replicate with prosthetic replacement and wherever possible attempts should be made to preserve the limb with further secondary reconstruction aimed at restoration of function. Casualty assessment, haemorrhage control and resuscitation are simultaneously undertaken at the receiving medical facility. Primary surgical management involves decontamination and debridement, skeletal stabilization, restoration of vascularity, compartment fasciotomy where indicated and wound temporization with dressings. Operative findings and interventions should be documented and if evacuation of the casualty is possible, copies should be provided in the medical records to facilitate communication in the chain of care. Secondary procedures are required for further assessment and debridement prior to planning reconstruction and definitive fracture stabilization, nerve repair, wound cover or closure.

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Concepts in wound irrigation of open fractures: ‘Where we came from, and where are we now?

Cited by 6 publications

References 57 publications

Pulsatile lavage systems and their potential to penetrate soft tissue

Pulsatile lavage systems and their potential to penetrate soft tissue

Panoramic Review of Open Fractures, Description, Epidemiology, Assessment, Classification, Treatment and Complications

Management of conflict injuries to the upper limb. Part 1: assessment and early surgical care

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