Authors: Branstetter JG, Lalliss SJ, Owens BD, Wenke JC, Brook Army Medical Center, Ft. Sam Houston, TX
Title: Comparison of High Pressure Parallel Flow and Bulb Syringe Irrigation in a Bioluminescent Musculoskeletal Wound Model
Purpose: The purpose of this study was to compare the efficacy of high pressure parallel flow and bulb syringe irrigation with debridement in reducing bacteria within a wound.
Methods: A complex musculoskeletal wound was created on the hind leg of twenty goats. The wound was contaminated with Pseudomonas aeruginosa (lux) bacteria, genetically modified to emit photons, thereby allowing quantification analysis of bacteria with a photon-counting camera system. The wounds were closed and animals were assigned to either the high pressure parallel flow irrigation group or the bulb syringe irrigation group. Each wound was debrided and irrigated at six and 48 hours after wounding and bacterial inoculation. Bacteria quantification was performed with use of a photon-counting camera before and after each treatment. Nine liters of saline was used and surgical sharp debridement was performed for each bulb syringe irrigation procedure. The volume of saline used in the parallel flow group was determined by the surgeon on a case-by-case basis with the criteria being removal of all tissue appearing to be necrotic and adequate lavage was performed.
Results: High pressure parallel flow irrigation and bulb syringe irrigation decreased the amount of bacteria to 10% and 19% of the pre-irrigation values at six hours, respectively (p = 0.02). The high pressure parallel flow irrigation group had an increase of bacteria to 51% of the initial baseline (pre-irrigation) amount and the bulb syringe irrigation group increased to 36% at the 48-hour time point (p = 0.39). A second debridement at the 48-hour time point reduced the bacteria in both groups to approximately 31% of the initial amount (p = 0.70). High pressure parallel flow irrigation required an average of 1.25 liters of saline per débridement and took 6.5 minutes less time to perform (29% decrease) than debridement and bulb syringe irrigation with nine liters. Assuming the hourly cost of an operating room is $748, the parallel flow would have saved $81.
Discuassion and Conclusion: The parallel flow device was more effective in removing bacteria at the initial debridement and irrigation and required less time and saline. This initial difference in bacteria did not persist at 48 hours. These results suggest that the parallel flow device is an adequate and efficient alternative to sharp débridement and irrigation using bulb syringe. The additional cost of the equipment for parallel flow irrigation may be offset by the reduction both the operating room time and saline required.