Journal reading

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Journal reading

• Present R3???
• Direct Dr. ???

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• Comparison of Bulb Syringe and Pulsed Lavage
  Irrigation with Use of a Bioluminescent
  Musculoskeletal Wound Model
• J Bone Joint Surg Am. 2006882167-2174.
• Early Wound Irrigation Improves the Ability to
  Remove Bacteria
• J Bone Joint Surg Am. 2007891723-1726.

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Management of open fracture

• Debridement as early as possible
• Irrigation
• Internal fixation or external fixation
• Check neurovascular injury

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Irrigation

• Timing
• Fluid Volume
• Fluid Type
• Sterile N/S
• Antiseptic soap. Iodine
• Antibiotics
• Delivery method
• Pulsed lavage
• Bulb syringe

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Objective

• To evaluate time effect and lavage device in
  wound irrigation by Bioluminescent
  Musculoskeletal Wound Model.

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Material and Method

• Bacteria
• Genetic engineering Pseudomonas aeruginosa
• Bioluminescent bacteria emit light in proportion
  to their number.
• Wound creation
• 12 goat
• Complex open wound over muscle, fasciae,
  periosteum and bone
• inoculated with 1 mL of gt108 CFU/mL of
  Pseudomonas aeruginosa

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Material and Method

• Pulsed lavage and bulb syringe
• 3L, 6L,9L
• Different tissue response
• Early irrigation
• 3hrs, 6hrs, 9hrs
• Pulsed lavage, 6L

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Wound creation
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(No Transcript)
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Pulsed lavage

• Minimal set up - spike and shoot
• Concurrent suction with soft cone splash shield
  for optimal fluid containment without damaging
  soft tissue
• Ergonomic shape to reduce muscle fatigue
• Completely disposable

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Result (Pulsed vs Bulb syringe)
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Result (Pulsed vs Bulb syringe)
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Result (Pulsed vs Bulb syringe)
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Result (Early irrigation)
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Result (Early irrigation)
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Discussion

• Pulsed lavage vs Bulb syringe
• Pressure difference
• Local inflammation
• Destroy viable tissue
• Propagate bacteria into tissue
• CORR 2005.439.27-31

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Discussion

• Time effect in the management of open fracture
• Antibiotics era
• Selection bias
• No prospective randomized controlled study.

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Discussion
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Biofilm formation
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Biofilm formation
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Limitation

• Animal study
• Small case number
• Pathogen
• Reduce bacteria count reduce infection rate???
• Role of debridement

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Conclusion

• Pulsed lavage system is more effective than bulb
  syringe and may allow less irragation volume used
• Early irrigation remove more bacteria