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Antibiotic solution applied by low pressure gravity flow device
5%
185/3814
Antibiotic solution applied by high pressure pulsatile flow device
2%
81/3814
Saline solution applied by low pressure gravity flow device
86%
3276/3814
Saline solution applied by high pressure pulsatile flow device
194/3814
Antibiotic solution applied by high pressure pulsatile flow device followed by low pressure gravity flow device
1%
57/3814
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Initial wound treatment is critical in the treatment of open fractures and contaminated wounds. Figures A and B reveal a Type IIIB open tibia fracture with obvious gross contamination and devitalized tissue. Systemic antibiotics and tetanus prophylaxis should be administered immediately upon arrival, and the lower extremity should be splinted while the remaining trauma workup takes place. Once cleared, this injury should be adequately debrided of all devitalized tissue and subsequently irrigated with a saline solution to reduce the bacterial count. Some evidence suggests that high-pressure pulsatile lavage damages bone structure and disrupts soft tissue. In an animal model, Hassinger et al showed that high-pressure pulsatile lavage caused deeper penetration of bacteria and results in greater bacterial retention in soft tissue when compared with low-pressure lavage. Owens et al, in a sheep model of contaminated soft tissue, compared low and high pressure lavage with normal saline solution, bacitracin solution, castile soap, and benzalkonium chloride. At 48 hours the group treated by low pressure lavage and saline showed the lowest rebound in bacterial counts.
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