Pulsatile lavage for wound debridement in compound fractures of leg: a randomized control trial

Abstract

Background: Management of compound fractures is a real challenge to the orthopaedic surgeon. Thorough wound irrigation and debridement is necessary to get a good outcome. Power-pulsed lavage (PPL) is a method of wound irrigation that has been popularised as an adjuvant in wound debridement. Methods: 39 patients of 28 to 40 years with Gustilo Anderson Type II and Type III fractures were divided in to two groups randomly and given pulsatile lavage or continuous flow lavage. Both the groups were followed up from January 2014 to January 2016, microbiology of the swab collected, pre and post lavage, and various other factors influencing the outcome were studied. Results: Most of the successful outcome was in the age group of 25-29 years (46.7%) and in the male gender 66.7%. The success outcome rate was 73.3% in those with Type II Gustilo Anderson fracture compared to Type III (26.7%). All persons with successful outcome had Tscherne grade II fracture. Also a clean or clean contaminated wound (CDC classification) had more chance for successful outcome (86.7%) than contaminated or dirty wounds. Conclusions: Heavy growth in pre-lavage blood agar culture was the single most important factor that determines the persistence of infection in compound fracture of both bones of leg. Type of lavage did not affect the union of fracture because presence of radiological signs of union was comparable in pulsatile group (66.7%) and continuous flow group (61.9%).

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

“…60,61 Various other alternatives in form of enzymes and laser have been designed and studied with little evidence, having benefits of hemostasis and depth of surgical excision. 62,63…”