Continuous Wound Irrigation in the Pig

Abstract

It was demonstrated in the pig that full-thickness wounds in the skin can be continuously treated by irrigation for several days. Irrigation was accomplished through a porous, occlusively applied dressing having two ports, one for supply and one for drainage. The fluid, delivered by means of an iv set, was sucked through the inert dressing, leaving it partially saturated, and with fluid spread evenly through its pores. Particulate matter was removed along narrow paths converging on the outlet, not showing any significant diversion. The apparatus for fluid supply and drainage was arranged to move with the animal, thus eliminating the risk of obstruction of the tubes as a result of twisting. The fluid was eliminated by one suction line, and the vacuum in the dressing maintained by another. This allowed the suction to be adjusted to a level near the atmospheric pressure.

The fluid dynamics of simultaneous irrigation with negative pressure wound therapy

“…Furthermore, cellular toxicity with surfactant use presents an issue and can cause tissue damage that delays wound healing . Decades prior to the first NPWT device being cleared by the USFDA in 1994, Pal Svedman, MD, PhD, reported the use of simultaneous irrigation in conjunction with NPWT to treat infected wounds . While NPWT with irrigation therapy is used frequently in the clinical setting, there are minimal controlled studies demonstrating the functionality of irrigation therapy and the efficacy of its use.…”

“…Saline irrigation has been shown both experimentally and clinically to be effective in decreasing bacterial contamination as well as infection rates . The addition of NPWT to saline irrigation was first reported in the late 1970s where a two‐port dressing was used to irrigate with saline while continuously applying negative pressure . Simultaneous irrigation administers irrigation solution and NPWT continuously with varying flow rates that are adjusted independent of NPWT pressure.…”

Negative pressure wound therapy

“…The irrigation systems assisted with avoiding the collection of blood, exudate, or infectious materials, and the negative pressure treatment facilitated granulation tissue development. 40 Antimicrobial gauze dressings (cotton blends). NPWT systems using moistened gauze typically recommend the Chariker-Jeter Technique where a nonadherent intervening contact layer covers the wound bed; moistened gauze is lightly layered to fill the wound space surrounding a flat, fenestrated drain and enclosed by a transparent polyethylene adhesive drape.…”

The Management of Lower Extremity Wounds Using Topical Negative Pressure

“…Various modifications of dressings, which applied negative pressure to the wound surface, were reported about the same time by a number of investigators. [4][5][6] However, the development of the standardized mechanism in current use, by which negative pressure is delivered uniformly over the surface area of a wound, is accredited to Morykwas and Argenta 7,8 in the United States and by Fleischmann in Germany. 9 Furthermore, the novelty of this therapy is manifested by its ability not merely to reduce fluid accumulation but by the vulnerary effects it exerts at cellular and molecular levels possibly via mechanical stress (mechanical transduction) at the foam wound interface.…”