Pulsed Lavage Irrigation
The Journal of Bone and Joint Surgery (American). 2006;88:2167-2174.
© 2006 The Journal of Bone and Joint Surgery, Inc.
Comparison of Bulb Syringe and Pulsed Lavage Irrigation with Use of a Bioluminescent Musculoskeletal Wound Model
Major Steven J. Svoboda, MD1 Terry G. Bice, MS1, Heather A. Gooden, BS1, Daniel E. Brooks, BS1, Darryl B. Thomas, MD1 and Joseph C. Wenke, PhD1
1 United States Army Institute of Surgical Research, 3400 Rawley E. Chambers Avenue, Fort Sam Houston, TX 78234-6315. E-mail address for J.C. Wenke: [email protected]
Investigation performed at the United States Army Institute of Surgical Research, Fort Sam Houston, Texas
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Background: Despite the fact that wound irrigation is a common surgical procedure, there are many variables, including delivery device, irrigant type, and fluid volume, that have yet to be optimized. The purpose of this study was to compare, with use of transgenic bioluminescent bacteria and standard quantitative microbiological methods, the efficacy of pulsed lavage and bulb syringe irrigation in reducing wound bacterial counts.
Methods: A caprine model of a complex, contaminated musculoskeletal wound was developed with use of a bioluminescent strain of Pseudomonas aeruginosa that can be quantified. Luminescent activity was recorded as relative luminescent units with use of a photon-counting camera six hours after the wound was created and inoculated. Twelve goats were randomly assigned to either the pulsed lavage group or the bulb syringe irrigation group. Each wound was irrigated with normal saline solution in 3-L increments for a total of 9 L and was imaged after each 3-L increment. In addition, quantitative culture samples were obtained from different tissues within the wound before and after irrigation.
Results: Pulsed lavage decreased the amount of relative luminescent units by 52%, 64%, and 70% at 3, 6, and 9 L, respectively. The bulb syringe irrigation reduced the amount of relative luminescent units by 33%, 44%, and 51% at these same time-points. Significant differences in luminescence were noted between the two groups after both 6 and 9 L of irrigation (p ≤ 0.04). The correlation coefficients between relative luminescent units and quantitative cultures for the condition before irrigation and after irrigation were r = 0.96 and 0.83, respectively.
Conclusions: Pulsed lavage was more effective than bulb syringe irrigation in reducing bacterial luminescence after both 6 and 9 L of irrigation. Both device and volume effects can be demonstrated with use of this model. Bioluminescent bacteria provide a method to visualize bacterial distribution and to quantify the bacteria in a wound.
Clinical Relevance: Pulsed lavage is a more effective and efficient method of irrigation to remove bacteria in a complex musculoskeletal wound. In the model we used, pulsed lavage irrigation with 3 L of saline solution resulted in a reduction of approximately the same amount of bacteria as did irrigation with 9 L with use of a bulb syringe.