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Scientific Articles   |    
Early Wound Irrigation Improves the Ability to Remove Bacteria
Brett D. Owens, MD1; Joseph C. Wenke, PhD1
1 United States Army Institute of Surgical Research, 3400 Rawley Chambers Road, Fort Sam Houston, TX 78234. E-mail address for B.D. Owens: b.owens@us.army.mil. E-mail address for J.C. Wenke: joseph.wenke@us.army.mil
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Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.
The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or reflecting the views of the Department of Defense or United States Government. The authors are employees of the United States Government. This work was prepared as part of their official duties and, as such, there is no copyright to be transferred.
Investigation performed at the United States Army Institute of Surgical Research, Fort Sam Houston, Texas

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2007 Aug 01;89(8):1723-1726. doi: 10.2106/JBJS.F.01210
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Abstract

Background: Although most surgeons prefer to treat contaminated wounds as soon as possible, the effect of timing on the ability of irrigation to reduce the amount of bacteria in a wound is not fully known. We evaluated the effect of different delays in irrigation on bacterial removal in an animal model.

Methods: A complex musculoskeletal wound was created in the proximal part of the leg of goats. The wound was contaminated with Pseudomonas aeruginosa (lux) bacteria, genetically modified to emit photons, in order to allow for quantitative analysis of bacterial concentration with a photon-counting camera system. The contaminated wounds were closed, and wound irrigation was performed with 6 L of normal saline solution by means of pulsatile lavage after the assigned time-intervals of three, six, and twelve hours. Images were made before and after treatment. Relative luminescent units and clearance ratios were obtained and calculated for each wound.

Results: Earlier wound irrigation resulted in superior bacterial removal in our model. Irrigation resulted in a 70% ± 2%, 52% ± 3%, and 37% ± 4% reduction in bacterial counts from the pre-irrigation level at three, six, and twelve hours, respectively. The clearance ratios were significantly different at all time-points (p < 0.004).

Conclusions: Earlier irrigation in our contaminated wound model resulted in superior bacterial removal.

Clinical Relevance: While the actual bacterial counts necessary to establish a wound infection in humans is unknown, early irrigation of the contaminated wound is recommended for the prevention of infection.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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