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Wound cleansing is an essential component of wound management used to facilitate the wound healing process. 1,2 Several methods are available for use by the physical therapist to achieve wound cleansing. 1-4 This update reviews the research
examining the effects of pulsed lavage in wound cleansing and comparisons with more traditional methods of wound cleansing.
The Necessity of Wound Cleansing
Normal wound healing is characterized by 3 overlapping phases: inflammatory, proliferative or fibroplastic, and remodeling.5,6 Vascular and cellular responses to trauma occurring during the inflammatory phase remove infectious microorganisms, foreign materials, and necrotic tissue from the wound's surface. During the proliferative phase, tissue granulation and reepithelialization occur .56 Collagen fibers are deposited in the dermis of the skin during the remodeling phase to strengthen the healing wound.
If the body's inflammatory response is inadequate to overcome surface microorganisms, a wound is predisposed to infection, delaying wound angiogenesis and granulation.7 In the 1950s, Liedberg et als showed that when bacterial concentrations of streptococci, pseudomonas, or staphylococci were greater than 100,000 organisms per gram in tissues, skin grafts on rabbits were destroyed. In 1969, Robson and Hegget9 summarized military and civilian studies examining the critical level of bacterial burden necessary to produce wound sepsis and failure to heal. They concluded that wound healing is possible only when bacterial counts are maintained at a concentration of 100,000 organisms per gram or less.
[Luedtke-Hoffmann KA, Schafer DS. Pulsed lavage in wound cleansing. Phys Ther. 2000;80:292-300.]
Key Words: Pulsed lavage, Wound cleansing, Wound irrigation.
Impediments to healing are not limited to the presence of microorganisms on the wound's surface. Winter, 10 for example, suggested that the presence of eschar or scab in a dry wound delays wound epithelialization and contraction. Likewise, Constantine and Bolton11 surmised that the presence of necrotic tissue or eschar, within the wound or at the wound's margin, impedes wound contraction and closure. Elek12 concluded that necrotic tissue in a wound provides an environment that facilitates wound infection. Current medical practice includes wound cleansing and debridement to remove impediments to the healing process to facilitate the progression from the inflammatory phase to the proliferative phase of wound healing.
The most common terms used to describe the actions taken to remove impediments to...