A critical review of irrigation techniques in acute wounds.

Irrigation is a fundamental concept to the care of acute wounds and therefore of prime importance in all surgical specialties. A significant amount of research has been done in search of the most effective irrigation technique over the last three decades. There is evidence to show that irrigation is beneficial in the management of acute traumatic and elective wounds, but exactly which techniques and irrigation pressures needed for optimal outcome are still undetermined. A significant number of the studies to date lack the rigid scientific design needed in a climate of evidence-based medicine. There are substantial methodological flaws and a lack of standardisation between many studies hindering the ability to draw scientific conclusion and compare different studies. There are few randomised, controlled studies on human wounds, and extrapolation from animal studies must be done with caution. Investigation into different irrigation pressures for different levels of contamination is lacking. This would possibly produce a more logical approach for clinically managing acute wounds rather than a blanket treatment for all acute wounds irrespective of the level of contamination. Further research in this direction with greater attention to scientific methodology and design is needed.