Efficacy of Power-pulsed Lavage in Lower Extremity Wound Infections: A Prospective Observational Study

Abstract 

Power-pulsed lavage is a common adjunct to surgical wound debridement, although few studies have examined the effect of this technique in lower extremity wounds. Fifty-five consecutively enrolled patients underwent 73 surgical debridements with power-pulsed lavage, and specimens were obtained for Gram stain and culture and sensitivity analyses before and after lavage. A number of risk factors were analyzed in regard to a successful outcome, which was defined as the absence of any organisms observed on the immediate postlavage culture. The incidence of a successful outcome was 69.86%, and debridement plus power-pulsed lavage statistically significantly decreased bacteria between the immediate prelavage and immediate postlavage specimens, for Gram stain (P = .0004) and culture (P = .005) analyses. Generalized estimation equations provided fully adjusted effect estimates that revealed a decreased likelihood of observing success if the patient's age was 85 years or older, or if rare or many organisms, or gram-negative rods, were present on the immediate prelavage Gram stain; whereas an increased likelihood of success was observed if the patient's body mass index was indicative of normal weight, and if few bacteria were noted on the immediate prelavage culture specimen. Based on these results, we concluded that power-pulsed lavage can be effective in decreasing the presence of bacteria in lower extremity wounds, and an awareness of the patient characteristics and microbiological factors associated with the persistence of bacteria may be helpful to surgeons treating such wounds.

Level of Clinical Evidence: 2

Keywords: culture and sensitivity, debridement, Gram stain, irrigation, surgery