3. Lavage of the wound is necessary to remove debris and reduce bacterial contamination. The solution to pollution is dilution.

• Low pressure, high-volume irrigation with bulb and syringe or gravity irrigation with large bore tubing are common options for wound irrigation.
  • 7 – 8 psi is recommended for wound irrigation and can be achieved by placing a 1-liter bag of fluids in a pressure cuff at 300 mmHg and attaching a hypodermic needle (16 to 22 gauge) to an extension line.⁵
• High pressure irrigation with pulsatile jet lavage irrigation may be available and can reduce bacterial contamination but can also result in tissue damage.⁹
• A standard volume for irrigation is not reported, but a general guideline reported in literature is 50 to 100 mL per centimeter of wound length.¹⁰
  • For wounds involving open fractures, common volumes include approximately 3 liters for Type I fractures, and 3-6 liters for Type II and III fractures, sometimes using as much as 9 liters for Type III fractures.¹¹

4. Generally, contaminated and dirty/infected wounds should not be sutured until healthy granulation tissue is established, in about 3 to 5 days. This is especially true for bite wounds.