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
Keywords
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Article info
Publication history
Published online: January 13, 2010
Footnotes
Financial Disclosure: None reported.
Conflict of Interest: None reported.
Identification
Copyright
© 2010 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.
