Irrigation of War Wounds

Irrigation of wounds is a common requirement of war surgery, and it prevents wound problems by removing debris, blood, and bacteria. Recent evidence challenges the current practice of routinely using high-pressure pulsatile lavage (HPPL) devices, and questions of fluids, additives, and volumes have been clarified.

Simple bulb irrigation or gravity irrigation is preferred. Although HPPL is fast, available, and easy to use in washing wounds, it also traumatizes tissue such that, at 2 days after HPPL, bacterial load rebounds more than with gentler methods (eg, bulb syringe use). Gentler methods lead to the least rebound and are the least expensive and widely available. Large-bore, gravity-run tubing should be used, which is as gentle as bulb syringe, but is faster and accepts two bags at once. Traditional debridement should be performed in addition to irrigation.

Research demonstrates that normal saline, sterile water, and potable tap water have similar usefulness and safety. The sterile isotonic solutions are readily available and remain the fluid of choice for irrigation. If unavailable, sterile water or potable tap water can be used.

No additive is recommended for routine irrigation of war wounds. Recommended, however, is warm saline in 3-L bags gravity-run as follows:

• 1 to 3 L for small-volume wounds
• 4 to 8 L for moderate wounds
• 9 or more liters for large wounds with heavy contamination