Pulsatile lavage in the management of postoperative wound infections

High-pressure pulsatile lavage is more effective than conventional irrigation in cleansing recently contaminated wounds. This method of irrigation was applied to postoperative infections in an attempt to lower wound bacterial counts to 10(5) or fewer organisms per gram of tissue, a level predictive of safe primary reclosure. Sequential wound biopsies for quantitative bacterial analysis demonstrated that high-pressure lavage is more effective than conventional irrigation in lowering bacterial counts in postoperative staphylococcal wound infections in guinea pigs. However, reductions were transient and did not lower counts sufficiently to permit safe reclosure. In contrast to results in newly contaminated wounds, pulsatile lavage of postoperative infections did not have therapeutic benefit. Reclosure of wounds with greater than 10(5) organisms per gram of tissue is unsafe even after five days of therapy.