Evidence-Based Wound Irrigation: Separating Fact from Fiction.

Area of Science:

• Wound Care
• Medical Best Practices
• Evidence-Based Medicine

Background:

• Wound irrigation is historically recognized but lacks standardized practices and official guidelines.
• Existing literature on wound irrigation lacks systematic review and practical application.

Purpose of the Study:

• To systematically review and summarize the evidence on wound irrigation practices.
• To propose evidence-based guidelines for improving wound healing and irrigation consistency.

Main Methods:

• Systematic literature review adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
• Inclusion of 31 high-quality studies involving 61,808 patients.
• Analysis of irrigation fluids, delivery methods, and treatment outcomes.

Main Results:

• Continuous gravity flow irrigation with polyhexanide is recommended for acute soft-tissue wounds.
• Continuous negative-pressure wound therapy with instillation is suggested for complex wounds (polyhexanide) and infected wounds (various agents including silver nitrate, polyhexanide, acetic acid, povidone-iodine).
• Gravity lavage with povidone-iodine or antibiotics for breast implant wounds and intraoperative povidone-iodine irrigation for surgical-site infection reduction were also noted.

Conclusions:

• The review establishes practical, evidence-based guidelines for wound irrigation to enhance healing.
• Proposed guidelines address specific wound types, including acute, complex, infected, and surgical-site infections.
• The findings aim to standardize wound irrigation protocols and improve patient outcomes.