IRRIGATION

There are several acceptable devices available for wound irrigation. Simple bulb syringe irrigation and gravity irrigation are the preferred methods. Large bore gravity-fed tubing is favored for irrigations requiring large fluid volumes, such as those associated with contaminated open fractures. Cystoscopy tubing connected to a 3 liter saline bag is ideal for gravity irrigation of large or multiple wounds. Pulsatile jet lavage irrigation using a battery powered system is not associated with improved outcomes but increases expense, weight, and space.6,7 All methods of wound irrigation are adjuncts and not substitutes to sharp surgical debridement.

The current recommendations for volume of irrigation are as follows:

- 1-3 liters for small volume wounds.
- 4-8 liters for moderate wounds.
- 9 or more liters for large wounds or wounds with evidence of heavy contamination.

This takes into account that bacterial loads drop logarithmically with increasing volumes of irrigation. Depending on the environment and medical logistics support, the volume of sterile fluids may not be available. Normal saline, sterile water and potable tap water all have comparable efficacy and safety as irrigation solutions.8,9 The inclusion of irrigation fluid additives such as iodine, bacitracin or antibiotics is without proven benefit.7