Irrigation Solutions in Wound Care and Breast Surgery: Evidence-Based Applications, Regulatory Considerations, and...

Irrigation is a key strategy in reducing bioburden, disrupting biofilms, and supporting wound healing. While saline is the standard for its safety and availability, antiseptic and antibiotic solutions are often used in clinical scenarios that require infection control. However, the rise in antibiotic stewardship and concerns regarding cytotoxicity are reshaping current practices. This review identifies recent trends, current controversies, and persistent gaps in knowledge that warrant further investigation and regulatory attention.

A literature review identified irrigation solutions commonly used in plastic surgery; labeling and concentrations were obtained from Devices@FDA, Drugs@FDA, and DailyMed, and PubMed, Cochrane Central, and Embase were searched (January 2022-July 2025) for human studies on acute wounds, chronic wounds, and implant-based breast surgery.

In acute wounds, saline and potable tap water effectively prevent infection. In chronic wounds, such as diabetic foot ulcers and pressure injuries, antiseptic agents, including hypochlorous acid, sodium hypochlorite, polyhexanide, and citrate-based solutions, have shown promise in improving healing and reducing infection. In implant-based breast reconstruction and augmentation, data on antiseptics, such as chlorhexidine, and changes in FDA guidance for povidone-iodine and bacitracin have prompted a reevaluation of intraoperative irrigation practices.

Despite widespread use, many antiseptics remain off-label, and high-quality clinical studies comparing efficacy and safety are lacking.