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Debridement of Cancellous Bone: A Comparison of Irrigation Methods

Objective: This study tests the bone debridement efficacy and damage to cancellous bone produced by different wound irrigation methods. Methods: Cancellous bone slices of bovine distal femurs (3 cm × 3 cm) were divided into eight test groups and scored with a saw in a latticed pattern. Four test groups were contaminated with 1.0 g rock dust and four were not. The specimens were then treated as follows: no treatment (control), bulb irrigation, brush-suction irrigation, or high-pressure pulsatile lavage (HPPL). Runoff from the irrigation was collected, filtered, lyophilized, and ashed to allow for quantitative determination of organic and inorganic material removed from the bone by each irrigation method. The bone samples were subjected to blinded grading on two five-point scales to assess: 1) macroscopic tissue damage and 2) amount of contaminant remaining following treatment. Results: Significantly more (P ≤ 0.05) mean organic material was removed from samples treated with HPPL (744.8 ± 120.0 mg) than with bulb syringe (115.2 ± 11.9 mg) or brush-suction irrigation (95.1 ± 9.2 mg). Brush-suction irrigation removed statistically significantly more (P ≤ 0.05) of the 1.0 g of initial inorganic contaminant (937.7 ± 6.3 mg) than bulb syringe irrigation (866.2 ± 30.1 mg), while HPPL (900.2 ± 19.0 mg) did not. Conclusions: Past studies have shown HPPL to damage both soft tissue and bone structure. The tissue damage that HPPL produces has been accepted in the past in exchange for its presumed superiority in contaminant removal. In this study, HPPL damaged samples more than other irrigation methods by removing significantly more organic material from them. However, HPPL and bulb syringe removed a statistically similar amount of inorganic contaminant, while brush-suction irrigation removed a significantly greater amount of inorganic contaminant than bulb syringe. It is proposed that HPPL may drive some contaminants deeper into the tissue rather than removing them, rendering HPPL not only more deleterious to bone structure and healing, but also less efficacious at removing contaminant than brush-suction irrigation.