Peripheral dissemination of bacteria in contaminated wounds; role of devitalized tissue: evaluation of therapeutic measures.

The role of available therapeutic agents in the management of infection has long been a continuing source of debate. This study assessed the rapidity of lateral dissemination of three common pyogenic organisms from wounds. The Streptococcus spreads peripherally with greater speed than the Staphylococcus or E. coli. Appraisal of the role and effectiveness of jet wound irrigation, debridement, and penicillin provides firm evidence that, of these three therapeutic agents, the only one that can control bacterial proliferation in a contaminated wound is the antibiotic. The primary role of energized jet irrigation is to remove clots and wound debris. The specific function of debridement is removal of devitalized tissue, in which role it has no effective competitor. These studies demonstrate that devitalized tissue in a contaminated wound quickens the rapidity of peripheral spread of all three micro-organisms. Systemic penicillin plus saline irrigation is the most effective therapeutic measure at both the second and fourth postinoculation hours in nondevitalized contaminated wounds. Debridement proved to be the most effective therapeutic device at the second, fourth, and sixth postinoculation hours in devitalized wounds.