Selective Mechanical Debridement in the Outpatient Setting with Pulsatile Irrigators

Background: Pressurized wound irrigation is an important adjunct to mechanical debridement of surgical wounds but has limited application in the chronic outpatient wound setting.

Purpose: This study evaluates the efficiency of a custom bag system to collect effluent at the bedside and assess the clinical experience of treating Class 3 or 4 wounds with selective mechanical debridement using this system.

Methods: The pulsatile irrigator has a maximum pressure of 15 PSI and each treatment was done with 3 liters of sterile saline. The bag kit for fluid collection was customized with a hole accommodating the wound height and width. Treatment was daily until angiogenesis was confirmed and then stepped down to 3 treatments per week. 

Results: The preliminary results of the first five cases are described. Patients presented with wounds staged as Class 3 or Class 4 at the initiation of irrigation treatment. Wound types were diagnosed as chronic diabetic foot ulcer (2), pressure decubitus (2) and venous stasis ulcers (1). In four cases, jet lavage treatment was initiated after other methods had been attempted for at least six weeks. All patients demonstrated substantial improvement of the wound, with edge control and greater than 50% progress toward wound closure. No complications were identified in any case. No patients complained of pain or irritation from the pulsatile jet lavage. Two wounds were over 175 cm/sq. One had completely healed after 4 months and the other had reduced to 70 cm/sq. One patient was on Eliquis during treatment having modest bloody oozing initially, which converted to bloodless irrigation after 10 days. 

Conclusions: Selective mechanical debridement with pulsatile irrigators is a classical surgical method that may have been overlooked in recent years for use in the outpatient setting. We find outpatient treatment to be efficient and highly effective and perhaps optimal for ‘early wound bed preparation’.