Pulsatile lavage for wound debridement in compound fractures of leg: a randomized control trial

Shafeed T. P., Bijo Paul


Background: Management of compound fractures is a real challenge to the orthopaedic surgeon. Thorough wound irrigation and debridement is necessary to get a good outcome. Power-pulsed lavage (PPL) is a method of wound irrigation that has been popularised as an adjuvant in wound debridement.

Methods: 39 patients of 28 to 40 years with Gustilo Anderson Type II and Type III fractures were divided in to two groups randomly and given pulsatile lavage or continuous flow lavage. Both the groups were followed up from January 2014 to January 2016, microbiology of the swab collected, pre and post lavage, and various other factors influencing the outcome were studied.

Results: Most of the successful outcome was in the age group of 25-29 years (46.7%) and in the male gender 66.7%. The success outcome rate was 73.3% in those with Type II Gustilo Anderson fracture compared to Type III (26.7%). All persons with successful outcome had Tscherne grade II fracture. Also   a   clean   or   clean   contaminated   wound (CDC classification) had more chance for successful outcome (86.7%) than contaminated or dirty wounds.

Conclusions: Heavy growth in pre-lavage blood agar culture was the single most important factor that determines the persistence of infection in compound fracture of both bones of leg. Type of lavage did not affect the union of fracture because presence of radiological signs of union was comparable in pulsatile group (66.7%) and continuous flow group (61.9%). 


Pulsatile lavage, Compound fracture, Heavy growth, Gustilo Anderson, Successful outcome

Full Text:



Brumback RJ. Inter observer agreement in the classification of open fractures of the tibia: the results of a survey of two hundred and forty-five orthopaedic surgeons. J Bone Joint Surgery Am. 1995;77:1291-2.

Hurvitz G, Zalavras C, Thordarson D. Debridement and primary closure of non healing foot wounds. Am J Orthopaedics. 2004;33:507-9.

Crowley DJ, Kanakaris NK, Giannoudis PV. Irrigation of the wounds in open fractures. J Bone Joint Surg. 2007;89(5):580-5.

Garner J, Hughes J, Davis B. CDC Guideline for prevention of surgical wound infections. Infect Control Hosp Epidemiol. 1986;7:193-200.

Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for prevention of surgical site infection, 1999. Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee. Am J Infect Control. 1999;27(2):97-132.

Green VA, Carlson HC, Briggs RL, Stewart JL. A comparison of the efficacy of pulsed mechanical lavage with that of rubber-bulb syringe irrigation in removal of debris from avulsive wounds. Oral Surg Oral Med Oral Pathol. 1971;32:158-64.

Rodeheaver GT, Pettry D, Thacker JG, Edgerton MT, Edlich RF. Wound cleansing by high pressure irrigation. Surg Gynecol Obstet. 1975;141:357-62.

Gross AG, Cutright DE, Bhaskar SN, Perez B, Beasley III JD. The effect of antibiotics and pulsating water jet lavage on contaminated wounds. Oral Surg Oral Med Oral Pathol. 1971;31:32-8.

Madden J, Edlich RE, Schauerhamer R. Application of principles of fluid dynamics to surgical wound irrigation. Current Topics in Surg Res. 1971;3:85-93

Mote GA, Malay S. Efficacy of Power-pulsed Lavage in Lower Extremity Wound Infections: A Prospective Observational Study. JFAS. 2010;49:135-42.

Bergstrom N, Bennett MA, Carlson CE. Treatment of Pressure Ulcers: Clinical Practice Guideline No. 15. Rockville, Md: US Department of Health and Human Services, Public Health Service. Agency for Health Care Policy and Research. 1994:6-7:47-53.

Barr JE. Principles of wound cleansing. Ostomy Wound Manage. 1997;43(1):15-21.

Weller K. In search of efficacy and efficiency: an alternative to conventional wound cleansing modalities. Ostomy Wound Manage. 1991;37:23-8.

Rodeheaver GT. Pressure ulcer debridement and cleansing: a review of current literature. Ostomy Wound Manage. 1999;45:80-5.

Feedar JA. Clinical management of chronic wounds. In: McCulloch JM, Kloth LC, Feedar JA, editors. Wound Healing: Alternatives in Management. 2nd edition. Philadelphia, Pa: FA Davis Co; 1995.