Fluid Lavage of Open Wounds

NCT ID: NCT00788398

Last Updated: 2016-02-11

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

2540 participants

Study Classification

INTERVENTIONAL

Study Start Date

2009-06-30

Study Completion Date

2015-04-30

Brief Summary

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Open fracture wounds are a constant challenge to orthopaedic surgeons, with infections a common complication. There is currently little evidence as to which is the most effective way to wash out these wounds. This study is a multi-center, prospective, randomized study. The infection rates will be compared between irrigation using high pressure versus low pressure versus gravity flow, and also saline versus a soap solution as the irrigation solution. The results from this study will help to determine the best method of washing out open fractures wounds. In this study, all open wounds will be washed out using methods commonly used by orthopaedic surgeons

Detailed Description

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Conditions

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Open Fracture Wounds

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

FACTORIAL

Primary Study Purpose

TREATMENT

Blinding Strategy

DOUBLE

Participants Outcome Assessors

Study Groups

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Saline, gravity flow

Group Type ACTIVE_COMPARATOR

Saline Solution

Intervention Type PROCEDURE

Irrigation with Saline

Gravity Flow Irrigation

Intervention Type PROCEDURE

Gravity flow irrigation will be standardized across participating centers as 3L bags of normal saline (alone or with soap solution) suspended 6-8 feet above floor level using an I.V. pole. Irrigation tubing (measuring 1/4 - 3/8 inch inner diameter) will be connected to the 3L bag and secured with a stopcock (or compressive device) until ready for use.

Saline, Low Pressure

Group Type ACTIVE_COMPARATOR

Saline Solution

Intervention Type PROCEDURE

Irrigation with Saline

Low Pressure Irrigation

Intervention Type PROCEDURE

Irrigation with the Stryker SurgiLav System. At the low pressure setting delivers 5.9 p.s.i. pressure. The high-flow irrigator tip will be held perpendicular to and 5cm above the wound.

Irrigation with the Zimmer PulsaVac. For low pressure delivery, the shower tip will be used at the low pressure setting which delivers a pressure of 5.8 p.s.i.

Saline, High Pressure

Group Type ACTIVE_COMPARATOR

Saline Solution

Intervention Type PROCEDURE

Irrigation with Saline

High Pressure

Intervention Type PROCEDURE

Irrigation with the Stryker SurgiLav System. For the high pressure delivery, the multi-orifice tip will be used at the high setting which delivers a pressure of 30 p.s.i.

Irrigation with the Zimmer PulsaVac System: For the high pressure delivery the shower tip will be used at the high pressure setting which delivers a pressure of 23 p.s.i.

Soap, Gravity Flow

Group Type ACTIVE_COMPARATOR

Soap solution

Intervention Type PROCEDURE

Irrigation with Castile Soap Solution (80 ml per 3L bag of saline)

Gravity Flow Irrigation

Intervention Type PROCEDURE

Gravity flow irrigation will be standardized across participating centers as 3L bags of normal saline (alone or with soap solution) suspended 6-8 feet above floor level using an I.V. pole. Irrigation tubing (measuring 1/4 - 3/8 inch inner diameter) will be connected to the 3L bag and secured with a stopcock (or compressive device) until ready for use.

Soap, low pressure

Group Type ACTIVE_COMPARATOR

Soap solution

Intervention Type PROCEDURE

Irrigation with Castile Soap Solution (80 ml per 3L bag of saline)

Low Pressure Irrigation

Intervention Type PROCEDURE

Irrigation with the Stryker SurgiLav System. At the low pressure setting delivers 5.9 p.s.i. pressure. The high-flow irrigator tip will be held perpendicular to and 5cm above the wound.

Irrigation with the Zimmer PulsaVac. For low pressure delivery, the shower tip will be used at the low pressure setting which delivers a pressure of 5.8 p.s.i.

Soap, high pressure

Group Type ACTIVE_COMPARATOR

Soap solution

Intervention Type PROCEDURE

Irrigation with Castile Soap Solution (80 ml per 3L bag of saline)

High Pressure

Intervention Type PROCEDURE

Irrigation with the Stryker SurgiLav System. For the high pressure delivery, the multi-orifice tip will be used at the high setting which delivers a pressure of 30 p.s.i.

Irrigation with the Zimmer PulsaVac System: For the high pressure delivery the shower tip will be used at the high pressure setting which delivers a pressure of 23 p.s.i.

Interventions

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Saline Solution

Irrigation with Saline

Intervention Type PROCEDURE

Soap solution

Irrigation with Castile Soap Solution (80 ml per 3L bag of saline)

Intervention Type PROCEDURE

Gravity Flow Irrigation

Gravity flow irrigation will be standardized across participating centers as 3L bags of normal saline (alone or with soap solution) suspended 6-8 feet above floor level using an I.V. pole. Irrigation tubing (measuring 1/4 - 3/8 inch inner diameter) will be connected to the 3L bag and secured with a stopcock (or compressive device) until ready for use.

Intervention Type PROCEDURE

Low Pressure Irrigation

Irrigation with the Stryker SurgiLav System. At the low pressure setting delivers 5.9 p.s.i. pressure. The high-flow irrigator tip will be held perpendicular to and 5cm above the wound.

Irrigation with the Zimmer PulsaVac. For low pressure delivery, the shower tip will be used at the low pressure setting which delivers a pressure of 5.8 p.s.i.

Intervention Type PROCEDURE

High Pressure

Irrigation with the Stryker SurgiLav System. For the high pressure delivery, the multi-orifice tip will be used at the high setting which delivers a pressure of 30 p.s.i.

Irrigation with the Zimmer PulsaVac System: For the high pressure delivery the shower tip will be used at the high pressure setting which delivers a pressure of 23 p.s.i.

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

1. Men or women who are skeletally mature.
2. Fracture of any extremity with complete radiographs.
3. Open fractures (Gustilo-Anderson Types I-IIIB) (Table 2)\*.
4. Fracture requiring operative fixation.
5. Provision of informed consent.

Exclusion Criteria

1. Open fractures with an associated vascular deficit (Gustilo-Anderson Type IIIC).
2. Known allergy to detergents or castile soap ingredients.
3. Previous wound infection or history of osteomyelitis in the injured extremity.
4. Previous fracture with retained hardware in injured extremity that will interfere with new implant fixation.
5. Surgical delay to operative wound management greater than 24 hours from hospital admission.
6. Use of immunosuppressive medication within 6 months.
7. Immunological deficient disease conditions (e.g. HIV).
8. Fracture of the hand (metacarpals and phalanges).
9. Fracture of the toes (phalanges).
10. Likely problems, in the judgment of the investigators, with maintaining follow-up. We will, for example, exclude patients with no fixed address, those who report a plan to move out of town in the next year, or intellectually challenged patients without adequate family support.
11. Previous randomization in this study or a competing study.
Minimum Eligible Age

14 Years

Maximum Eligible Age

85 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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McMaster University

OTHER

Sponsor Role collaborator

United States Department of Defense

FED

Sponsor Role collaborator

Prisma Health-Upstate

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Kyle J. Jeray, MD

Role: PRINCIPAL_INVESTIGATOR

Greenville Hospital System

Bradley Petrisor, MD

Role: PRINCIPAL_INVESTIGATOR

Hamilton Health Sciences Corporation

Mohit Bhandari, MD

Role: PRINCIPAL_INVESTIGATOR

McMaster University

Gordan Guyatt, M.D.

Role: PRINCIPAL_INVESTIGATOR

McMaster University

Locations

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Univeristy of Alabama at Birmingham

Birmingham, Alabama, United States

Site Status

University of California-Irvine

Orange, California, United States

Site Status

University of California- San Francisco

San Francisco, California, United States

Site Status

Wishard Health Services, Indiana University

Indianapolis, Indiana, United States

Site Status

Lahey Clinic

Burlington, Massachusetts, United States

Site Status

Orthopaedic Associates of Michigan

Grand Rapids, Michigan, United States

Site Status

Hennepin County Medical Center

Minneapolis, Minnesota, United States

Site Status

University of Missouri Health Care

Columbia, Missouri, United States

Site Status

St. Louis University

St Louis, Missouri, United States

Site Status

Duke University

Durham, North Carolina, United States

Site Status

Miami Valley Hospital/Wright State University

Dayton, Ohio, United States

Site Status

University of Pittsburg

Pittsburgh, Pennsylvania, United States

Site Status

Greenville Hospital System

Greenville, South Carolina, United States

Site Status

Brooke Army Medical Center

Fort Sam Houston, Texas, United States

Site Status

The Alfred

Prahran, , Australia

Site Status

Royal Columbian Hospital-New Wesminster

New Westminster, British Columbia, Canada

Site Status

Vancouver General Hospital

Vancouver, British Columbia, Canada

Site Status

Health Sciences Winnipeg

Winnipeg, Manitoba, Canada

Site Status

Queen Elizabeth II Health Sciences Center

Halifax, Nova Scotia, Canada

Site Status

Hamilton Health Sciences

Hamilton, Ontario, Canada

Site Status

McMaster University

Hamilton, Ontario, Canada

Site Status

London Health Sciences

London, Ontario, Canada

Site Status

Ottawa Hospital- Civic

Ottawa, Ontario, Canada

Site Status

Sunnybrook Health Sciences Centre

Toronto, Ontario, Canada

Site Status

St. Michael's Hospital

Toronto, Ontario, Canada

Site Status

McGill University Health Centre

Montreal, Quebec, Canada

Site Status

Hospital du Sacre-Coeur de Montreal

Montreal, Quebec, Canada

Site Status

Hôpital de l'Enfant-Jésus

Québec, Quebec, Canada

Site Status

Université de Sherbrooke

Sherbrooke, Quebec, Canada

Site Status

Sancheti Institute

Prune, , India

Site Status

Ulleval University Hospital

Oslo, , Norway

Site Status

Countries

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United States Australia Canada India Norway

References

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Tornetta P 3rd, Della Rocca GJ, Morshed S, Jones C, Heels-Ansdell D, Sprague S, Petrisor B, Jeray KJ, Del Fabbro G, Bzovsky S, Bhandari M; FLOW Investigators. Risk Factors Associated With Infection in Open Fractures of the Upper and Lower Extremities. J Am Acad Orthop Surg Glob Res Rev. 2020 Dec 8;4(12):e20.00188. doi: 10.5435/JAAOSGlobal-D-20-00188.

Reference Type DERIVED
PMID: 33986214 (View on PubMed)

Prada C, Marcano-Fernandez FA, Schemitsch EH, Bzovsky S, Jeray K, Petrisor B, Bhandari M, Sprague S; FLOW Investigators. Timing and Management of Surgical Site Infections in Patients With Open Fracture Wounds: A Fluid Lavage of Open Wounds Cohort Secondary Analysis. J Orthop Trauma. 2021 Mar 1;35(3):128-135. doi: 10.1097/BOT.0000000000001912.

Reference Type DERIVED
PMID: 33105456 (View on PubMed)

Busse JW, Heels-Ansdell D, Makosso-Kallyth S, Petrisor B, Jeray K, Tufescu T, Laflamme Y, McKay P, McCabe RE, Le Manach Y, Bhandari M; Fluid Lavage of Open Wounds Investigators. Patient coping and expectations predict recovery after major orthopaedic trauma. Br J Anaesth. 2019 Jan;122(1):51-59. doi: 10.1016/j.bja.2018.06.021. Epub 2018 Aug 6.

Reference Type DERIVED
PMID: 30579406 (View on PubMed)

Sprague S, Tornetta P 3rd, Slobogean GP, O'Hara NN, McKay P, Petrisor B, Jeray KJ, Schemitsch EH, Sanders D, Bhandari M; FLOW Investigators. Are large clinical trials in orthopaedic trauma justified? BMC Musculoskelet Disord. 2018 Apr 20;19(1):124. doi: 10.1186/s12891-018-2029-3.

Reference Type DERIVED
PMID: 29678204 (View on PubMed)

Shea P, O'Hara NN, Sprague SA, Bhandari M, Petrisor BA, Jeray KJ, Zhan M, Slobogean GP, Pensy RA; Fluid Lavage in Open Wounds Investigators. Wound Surface Area as a Risk Factor for Flap Complications among Patients with Open Fractures. Plast Reconstr Surg. 2018 Jul;142(1):228-236. doi: 10.1097/PRS.0000000000004418.

Reference Type DERIVED
PMID: 29608532 (View on PubMed)

FLOW Investigators; Bhandari M, Jeray KJ, Petrisor BA, Devereaux PJ, Heels-Ansdell D, Schemitsch EH, Anglen J, Della Rocca GJ, Jones C, Kreder H, Liew S, McKay P, Papp S, Sancheti P, Sprague S, Stone TB, Sun X, Tanner SL, Tornetta P 3rd, Tufescu T, Walter S, Guyatt GH. A Trial of Wound Irrigation in the Initial Management of Open Fracture Wounds. N Engl J Med. 2015 Dec 31;373(27):2629-41. doi: 10.1056/NEJMoa1508502. Epub 2015 Oct 8.

Reference Type DERIVED
PMID: 26448371 (View on PubMed)

Flow Investigators. Fluid lavage of open wounds (FLOW): design and rationale for a large, multicenter collaborative 2 x 3 factorial trial of irrigating pressures and solutions in patients with open fractures. BMC Musculoskelet Disord. 2010 May 6;11:85. doi: 10.1186/1471-2474-11-85.

Reference Type DERIVED
PMID: 20459600 (View on PubMed)

Other Identifiers

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W81XWH-08-1-0473

Identifier Type: -

Identifier Source: secondary_id

GHS-03-08-06

Identifier Type: -

Identifier Source: org_study_id

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