Goal: Because war wounds are most often grossly contaminated, proper irrigation techniques should be implemented as early as possible after wounding to reduce the possibility of infection. Pressure, fluid choice, and fluid amount are the tenants of irrigation: the solution to pollution is dilution.

 

Irrigation notes:

Half-strength Dakin’s Solution

  1. 1L water, sterile or boiled
  2. 5mL household bleach (5.25% hypochlorite solution, unscented)
  3. Sodium bicarbonate: 1.5mL (1/2 tsp) of baking soda or 4 ampules (200mL) of 8.5% sodium bicarbonate injection (preferred, but can leave out if not available)
  4. Once mixed, Dakin’s solution can be stored. The half-strength solution should be diluted 1:10 with water for wound irrigation solution.

Debris made of wood, vegetative material, clothing, and any debris in the foot should be excised and/or removed if possible; however, foreign bodies penetrating into vital structures, including the eye, should be left in place until the patient can reach a surgical capability. Most retained metal fragments do not need to be removed, particularly if doing so creates additional tissue damage.