Aggressive excision and wound closure are effective treatments to improve severe burn outcomes, but some open wounds can still linger. “This can cause further inflammation and invasive infections during the procedure,” explains Xu-Lin Chen, PhD. Skin grafting failure after excision and infection are crucial factors that can lead to sepsis, the most common cause of death in patients with severe burns. The challenge for clinicians is to increase the take rate of grafting and reduce the incidence of infections after aggressive excision.
Pulsed lavage is a high-pressure irrigation technique primarily used to debride wounds. During this procedure, bacteria and dirt on the wound surface are separated from the tissue using vibrations from a pulsed liquid flow during debridement. Pulsed lavage irrigation has been widely used in orthopedic procedures to reduce postoperative infection rates, but more recently, researchers have speculated that pulsed lavage can be used to effectively clean the wound bed in patients with severe burns.
Pulsed Lavage for Burns
Dr. Chen and colleagues conducted a study, published in Medical Science Monitor, that investigated the effects of pulsed lavage during early excision on infection control, autografting, and mortality among patients with severe burns. The retrospective study, conducted at a single center, evaluated the efficacy of pulsed lavage following excision of burns that were 30% or more of the TBSA in 63 patients. Participants had second- and third-degree burns, and causes included thermal, chemical, and electrical burns.
Patients with early aggressive excision were divided into pulsed lavage and control groups. Evaluations of wound healing and complications were based on wound healing rates and times, clinical symptoms, and examinations. Specifically, investigators gathered data on the take rate of skin grafting, the positive rate of postoperative bacterial cultures, changes in perioperative serum C-reactive protein (CRP) and procalcitonin (PCT) levels, and the incidence of secondary grafting.
Pulsed Lavage Shows Promise for Severe Burns
The take rate of skin grafting—one of the most reliable indicators of effective burn wound healing, according to Dr. Chen and team—was significantly higher in the pulsed lavage group than in the control group. In addition, perioperative serum CRP and PCT levels were significantly lower for patients who received pulsed lavage (Figure). Furthermore, postoperative bacterial cultures were positive in just 6.67% of cases in the pulsed lavage group, compared with 36.4% of control group cases.
The study also indicated that using pulsed lavage on burn wounds after early excision had a more positive effect on recovery when compared with conventional irrigation. To assess recovery, the study team analyzed unplanned skin grafting reoperations in both patient groups. No significant differences were observed, with reoperation rates of 20.0% for those receiving pulsed lavage and 33.3% for the controls. Importantly, no mortalities were seen in the pulsed lavage group, compared with a 12.1% mortality rate for the control group.
Findings Valuable for Future Care
How burn wounds are treated plays a vital role in wound healing, which in turn influences patients’ prognosis and QOL. That severe burns are associated with significant pain and distress and a reduced QOL highlights the critical need for effective interventions. “Results from our study may prove valuable in the future of wound treatment for severe burns,” Dr. Chen says. The findings demonstrated a more rapid decrease in the systemic inflammatory response with pulsed lavage, which, in turn, helped promote physical function for a better and faster recovery. The study team noted that they intend to continuously update their reference data and more thoroughly explore factors that could impact wound healing with pulsed lavage therapy in future research.