Hollander J E, Richman P B, Werblud M, Miller T, Huggler J, Singer A J
Department of Emergency Medicine, University Medical Center, State University of New York at Stony Brook, USA.
Ann Emerg Med. 1998 Jan;31(1):73-7. doi: 10.1016/s0196-0644(98)70284-7.
Animal and human studies suggest that irrigation lowers the infection rate in contaminated wounds, but there is no evidence that this common practice is beneficial for "clean" lacerations. We tested the null hypothesis that there is no difference in the infection rate for noncontaminated lacerations to the face and scalp that are irrigated before primary closure compared with similar wounds that are closed primarily without irrigation.
We performed a cross-sectional study of consecutive patients presenting to a suburban, academic emergency department between October 1992 and August 1996. Patients with nonbite, noncontaminated facial skin or scalp lacerations who presented less than 6 hours after injury were included. Structured, closed-question data collection instruments were completed at the time of laceration repair and at suture removal. The primary outcome parameters were the incidence of wound infection and the short-term cosmetic appearance of lacerations in patients who did or did not receive irrigation.
A total of 1,923 patients were included in the study group; 1,090 patients received saline irrigation, and 833 patients did not. The irrigation and nonirrigation groups were similar with regard to time from injury to presentation (1.56 versus 1.42 hours, respectively), frequency of linear wound morphology (82% versus 88%), frequency of smooth wound margins (72% versus 82%), number of layers of closure (1.14 versus 1.26), number of skin sutures applied (4.98 versus 4.65), number of deep sutures applied (.70 versus 1.05), and use of oral antibiotic prophylaxis (2.8% versus 4.0%). With respect to outcomes, the incidence of wound infection was not significantly different between the two treatment groups (.9% versus 1.4%, respectively; P = .28). Likewise, the percentage of patients who had an "optimal" cosmetic appearance was similar in the two groups (75.9% versus 81.7%, respectively; P = .07).
Irrigation before primary closure did not significantly alter the rate of infection or the cosmetic appearance in our study population with clean, noncontaminated facial and scalp lacerations.
动物和人体研究表明，冲洗可降低污染伤口的感染率，但尚无证据表明这种常见做法对“清洁”裂伤有益。我们检验了一个无效假设，即与未冲洗直接缝合的类似伤口相比，在一期缝合前冲洗的面部和头皮未污染裂伤的感染率没有差异。
我们对1992年10月至1996年8月期间到一家郊区学术急诊科就诊的连续患者进行了一项横断面研究。纳入受伤后6小时内就诊的非咬伤、未污染的面部皮肤或头皮裂伤患者。在裂伤修复时和拆线时完成结构化的封闭式问题数据收集工具。主要结局参数是接受或未接受冲洗的患者伤口感染的发生率和裂伤的短期美容外观。
研究组共纳入1923例患者；1090例患者接受了生理盐水冲洗，833例患者未接受冲洗。冲洗组和未冲洗组在受伤至就诊时间（分别为1.56小时和1.42小时）、线性伤口形态频率（82%对88%）、伤口边缘光滑频率（72%对82%）、缝合层数（1.14对1.26）、应用皮肤缝线数量（4.98对4.65）、应用深部缝线数量（0.70对1.05）以及口服抗生素预防用药情况（2.8%对4.0%）方面相似。关于结局，两个治疗组的伤口感染发生率无显著差异（分别为0.9%对1.4%；P = 0.28）。同样，两组中美容外观“最佳”的患者百分比相似（分别为75.9%对81.7%；P = 0.07）。
在我们研究的清洁、未污染的面部和头皮裂伤人群中，一期缝合前冲洗并未显著改变感染率或美容外观。
