The effect of antibiotics and pulsating water jet lavage on contaminated wounds

Gross, Arthur; Cutright, Duane E.; Bhaskar, Surindar N.; Perez, Bienvenido; Beasley, J. N.

doi:10.1016/0030-4220(71)90030-2

Cited by 27 publications

(19 citation statements)

References 13 publications

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“…In most of these models, surgical incisions are made and the wounds are then inoculated with bacteria, ranging from 10 5 to 10 9 bacterial colonies. [10][11][12][13][14][15] These experiments have provided valuable knowledge demonstrating that crush wounds, burst stellate lacerations, and wounds contaminated with soil are associated with increased infection rates. These studies have been extrapolated to the clinical setting to define high-risk lacerations.…”

Section: Discussionmentioning

confidence: 99%

“…Data derived from the animal laboratory usually result from a model where between 10 5 and 10 9 bacterial colonies are inoculated into surgical incisions. [10][11][12][13][14][15] Extrapolation to the clinical setting where most lacerations may have less than 10 2 bacterial colonies is unclear. 16,17 Likewise, extrapolation from the setting of elective operative incisions to the ED setting is also of unclear significance.…”

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confidence: 99%

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Risk Factors for Infection in Patients with Traumatic Lacerations

Hollander

Singer

Valentine

et al. 2001

Academic Emergency Medicine

103

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Abstract. Background: Most of our knowledge of laceration management comes from studies in animal models or patients with closure of sterile postoperative surgical incisions. Traumatic laceration management has not been well studied. Objective: To determine which characteristics of traumatic lacerations were associated with the development of wound infection. Methods: A cross-sectional study of consecutive patients with traumatic lacerations repaired over a four-year period was conducted. Structured closedquestion data sheets were prospectively completed at the time of laceration repair and suture removal. Infection was determined at the time of suture removal. Multivariate modeling was used to determine the adjusted odds ratio (OR) of infection. Results: Five thousand five hundred twenty-one patients were enrolled; 195 patients developed an infection (3.5%). An increased likelihood of wound infection was associated with age (adjusted OR per year, 1.01; 95% CI = 1.0 to 1.02); history of diabetes mellitus (adjusted OR 6.7; 95% CI = 1.7 to 26.4); laceration width (adjusted OR 1.05 per mm; 95% CI = 1.02 to 1.08); and presence of foreign body (adjusted OR 2.6; 95% CI = 1.3 to 5.2). Laceration location on the head/neck was associated with a decreased risk of infection (adjusted OR 0.28; 95% CI = 0.18 to 0.45). Conclusions: Both patient and wound characteristics of traumatic lacerations have an influence on the likelihood of infection. This knowledge may be valuable for determining whether various methods of wound cleansing, debridement, and repair can improve the outcome of patients with traumatic lacerations. Key words: wounds; lacerations; sutures; infection; cosmetic appearance; outcomes. ACADEMIC EMERGENCY MEDICINE 2001; 8:716-720 L ACERATIONS and open wounds are the third most commonly encountered problems in the emergency department (ED), accounting for 8% of the 95 million annual ED visits in the United States.1 The ultimate goals of wound management are to avoid infection and achieve a functional and cosmetically acceptable scar.2,3 Although death and life-threatening morbidity from traumatic lacerations are rare, improper management may lead to an increased likelihood of wound infection and a decreased likelihood of achieving a cosmetically appealing outcome. These largely avoidable outcomes may result in significant patient inconvenience or long-term psychological sequelae.Most studies of wound care have focused on postoperative infection rate.3-9 Current practices are generally derived empirically, based on obser- vations in animal models or extrapolation from data derived in the operating room. Data derived from the animal laboratory usually result from a model where between 10 5 and 10 9 bacterial colonies are inoculated into surgical incisions. [10][11][12][13][14][15] Extrapolation to the clinical setting where most lacerations may have less than 10 2 bacterial colonies is unclear. 16,17 Likewise, extrapolation from the setting of elective operative incisions to the ED setting is also of unclear si...

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Risk Factors for Infection in Patients with Traumatic Lacerations

Hollander

Singer

Valentine

et al. 2001

Academic Emergency Medicine

103

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“…Majority of the fracture patterns were of Gustilo and Anderson classification Type II (46.2%) and Tscherne grading Grade II (87.2%). Most of the persons (48.7%) had a clean contaminated wound 8,9 (CDC classification) while in another study by Gregory A. Mote, Scot Malay majority had contaminated wound (35.6%). [11][12][13] Almost same number of persons underwent interlocking nail (46.2%) and external fixation (41%).…”

Section: Discussionmentioning

confidence: 99%

“…8,9 The study included total of 39 persons who sustained Gustilo and Anderson type II/III fracture both bones leg. They were divided into two groups randomly to those who would undergo pulsatile flow lavage (18 persons) and those who would receive the continuous flow lavage (21 persons).…”

Section: Discussionmentioning

confidence: 99%

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

Shafeed¹,

Paul²

2016

Int J Res Orthop

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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%).

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“…Bahrs et al 10 concluyeron que la irrigación manual continua es una técnica efectiva para la reducción bacteriana sobre superficies contaminadas. Gross et al 11,12 demostraron que el uso de sistemas de lavado a presión disminuye el número de bacterias y la incidencia de infecciones de heridas quirúrgicas. La efectividad Fecha de recepción: 08-07-10 Fecha de aprobación: 08-11 -10 de la reducción bacteriana está determinada principalmente por la presión de irrigación, como lo demostraron Rodeheaver et al 13 Según Bhandari et al…”

Section: Introductionunclassified

Efecto inflamatorio comparativo de soluciones irrigantes antisépticas frente a irrigación convencional con cloruro de sodio en ratas

Alfaro

Chumpitaz-Cerrate

Sánchez

et al. 2014

Odontol. sanmarquina

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El objetivo del presente estudio fue demostrar que el uso de soluciones irrigantes en procedimientos quirúrgicos no modifica los procesos de inflamación y reparación tisular. Se formaron cuatro grupos de 15 ratas cada uno, a las cuales tras la anestesia general se les realizó osteotomía en la tibia con fresa de carburo tungsteno e irrigación durante 15 segundos, utilizando las siguientes soluciones en cada grupo: A) clorhexidina al 0,12 % más cetilpiridinio 0,05 %; B) clorhexidina al 0,12 % más aspartame; C) hexetidina 0,1 %; D) cloruro de sodio 0,9 %. A los 3, 7 y 15 días de la intervención, se sacrificó a las ratas, y se extrajo muestras del tejido intervenido para su análisis histopatológico. Los resultados obtenidos demostraron que los grupos en los que se empleó clorhexidina más cetilpiridinio y clorhexidina más aspartame mostraron un proceso inflamatorio menor al obtenido en los grupos de cloruro de sodio y hexetidina; en cuanto al proceso de reparación tisular, los cuatro grupos siguieron un patrón similar, con la observación de que el grupo en el que se empleó hexetidina hubo una reparación más intensa a los 7 y 15 días. Se concluye que la utilización de clorhexidina más cetilpiridinio y clorhexidina más aspartame disminuye el proceso inflamatorio post quirúrgico en relación a los otros grupos, mientras que el proceso de reparación tisular fue similar en todos los grupos, con una intensidad mayor a los 7 y 15 días para el grupo de hexetidina.

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The effect of antibiotics and pulsating water jet lavage on contaminated wounds

Cited by 27 publications

References 13 publications

Risk Factors for Infection in Patients with Traumatic Lacerations

Risk Factors for Infection in Patients with Traumatic Lacerations

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

Efecto inflamatorio comparativo de soluciones irrigantes antisépticas frente a irrigación convencional con cloruro de sodio en ratas

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