An improved method for closed-system, irrigation-suction, antibiotic-detergent treatment of deep infected wounds has been described. Most of the twenty-four patients in the present series had acute infections of the musculoskeletal system but there were some chronic infections.
The method has been simplified by the use of a preoperatively prepared surgical pack and a crisscross flow-reversal arrangement of the tubing. Insertion of the tubes through puncture wounds at surgery is facilitated by the use of Steinmann pins of the proper diameter, which eliminate the likelihood of leakage about the tubes.
It is convenient to have three intravenous bottles in place. The desired solution may be selected by appropriate application of clamps on the tubing. One intravenous bottle contains Clorpactin XCB, 0.5 per cent; another, normal saline; the third, Alevaire and the selected antibiotic in normal saline.
Precautions in the use of the materials are discussed. The ability to regulate or reverse the flow of solutions precisely is increased by the crisscross tubes. The crisscross flow-reversal feature is considered essential for the prevention of pooling, sinus formation, and clogging of tubes, and as a means to assure maximum contact of the solutions with all parts of wound.