Fluid Lavage of Open Wounds (FLOW): Pilot Trial

Fluid Lavage of Open Wounds (FLOW): A Multi-Center, Blinded, Factorial Pilot Trial Comparing Alternative Irrigating Solutions and Pressures in Patients With Open Fractures

The purpose of this trial is to investigate whether irrigation solution (soap vs. saline solution), or irrigation pressure (high vs. low) will decrease the rate of infection among patients with open fracture wounds.

Open fractures are an important source of morbidity and are associated with delayed union, nonunion, and infection. Preventing infection through meticulous irrigation and debridement is an important goal in management, and different lavage fluids and irrigation techniques (e.g. high or low pressure lavage) have been described for this purpose. There are, however, a limited number of randomized trials comparing irrigating solutions or irrigating technique. We compared the use of castile soap versus normal saline, as well as high versus low pressure pulsatile lavage on the rates of reoperations and complications in patients with open fracture wounds.

Inclusion Criteria:

• skeletally mature
• sustained an open fracture of the appendicular skeleton (type I to IIIb).

Exclusion Criteria:

• vascular deficit
• [any] allergy to detergents or castile soap
• previous wound infection or osteomyelitis
• previous fracture with retained hardware in the injured extremity
• operative management more than 24 hours after injury
• use of immunosuppressive medication within six months
• immunological deficiency or disease conditions
• fractures of the hands (distal to the carpus) or toes