Fluid Lavage of Open Wounds (FLOW): Pilot Trial

NCT ID: NCT01069315

Last Updated: 2019-03-18

Study Results

Results available

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

111 participants

Study Classification

INTERVENTIONAL

Study Start Date

2006-07-31

Study Completion Date

2008-06-30

Brief Summary

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The purpose of this trial is to investigate whether irrigation solution (soap vs. saline solution), or irrigation pressure (high vs. low) will decrease the rate of infection among patients with open fracture wounds.

Detailed Description

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Open fractures are an important source of morbidity and are associated with delayed union, nonunion, and infection. Preventing infection through meticulous irrigation and debridement is an important goal in management, and different lavage fluids and irrigation techniques (e.g. high or low pressure lavage) have been described for this purpose. There are, however, a limited number of randomized trials comparing irrigating solutions or irrigating technique. We compared the use of castile soap versus normal saline, as well as high versus low pressure pulsatile lavage on the rates of reoperations and complications in patients with open fracture wounds.

Conditions

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Infection Wound Healing Problem Nonunion

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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Normal saline and High pressure

Irrigation with normal saline delivered at high pressure

Group Type EXPERIMENTAL

Type of fluid lavage solution

Intervention Type PROCEDURE

Comparison of castile soap solution vs. normal saline solution.

Type of fluid lavage pressure

Intervention Type PROCEDURE

Comparison of low pressure vs. high pressure.

Soap solution and High pressure

Irrigation with soap solution delivered at high pressure

Group Type EXPERIMENTAL

Type of fluid lavage solution

Intervention Type PROCEDURE

Comparison of castile soap solution vs. normal saline solution.

Type of fluid lavage pressure

Intervention Type PROCEDURE

Comparison of low pressure vs. high pressure.

Normal saline and Low pressure

Irrigation with saline solution delivered at low pressure

Group Type EXPERIMENTAL

Type of fluid lavage solution

Intervention Type PROCEDURE

Comparison of castile soap solution vs. normal saline solution.

Type of fluid lavage pressure

Intervention Type PROCEDURE

Comparison of low pressure vs. high pressure.

Soap solution and Low pressure

Irrigation with soap solution delivered at low pressure

Group Type EXPERIMENTAL

Type of fluid lavage solution

Intervention Type PROCEDURE

Comparison of castile soap solution vs. normal saline solution.

Type of fluid lavage pressure

Intervention Type PROCEDURE

Comparison of low pressure vs. high pressure.

Interventions

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Type of fluid lavage solution

Comparison of castile soap solution vs. normal saline solution.

Intervention Type PROCEDURE

Type of fluid lavage pressure

Comparison of low pressure vs. high pressure.

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* skeletally mature
* sustained an open fracture of the appendicular skeleton (type I to IIIb).

Exclusion Criteria

* vascular deficit
* \[any\] allergy to detergents or castile soap
* previous wound infection or osteomyelitis
* previous fracture with retained hardware in the injured extremity
* operative management more than 24 hours after injury
* use of immunosuppressive medication within six months
* immunological deficiency or disease conditions
* fractures of the hands (distal to the carpus) or toes
Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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The Physicians' Services Incorporated Foundation

OTHER

Sponsor Role collaborator

Orthopaedic Trauma Association

OTHER

Sponsor Role collaborator

McMaster University

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Mohit Bhandari, MD, FRCSC

Role: STUDY_CHAIR

McMaster University

Mohit Bhandari, MD, FRCSC

Role: PRINCIPAL_INVESTIGATOR

McMaster University

Gordon Guyatt, MD, FRCSC

Role: PRINCIPAL_INVESTIGATOR

McMaster University

Kyle J Jeray, MD, FRCSC

Role: PRINCIPAL_INVESTIGATOR

McMaster University

Locations

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University of Missouri Health Care

Columbia, Missouri, United States

Site Status

Greenville Hospital System

Greenville, South Carolina, United States

Site Status

East Texas Medical Centre

Tyler, Texas, United States

Site Status

Queen Elizabeth II Health Sciences Centre

Halifax, Nova Scotia, Canada

Site Status

Hamilton Health Sciences

Hamilton, Ontario, Canada

Site Status

Ottawa Hospital - Civic Campus

Ottawa, Ontario, Canada

Site Status

St. Michael's Hospital

Toronto, Ontario, Canada

Site Status

Sunnybrook Health Sciences Centre

Toronto, Ontario, Canada

Site Status

Sancheti Institute for Orthopaedics & Rehabilitation

Pune, Maharashtra, India

Site Status

Countries

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United States Canada India

References

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Anglen JO, Gainor BJ, Simpson WA, Christensen G. The use of detergent irrigation for musculoskeletal wounds. Int Orthop. 2003;27(1):40-6. doi: 10.1007/s00264-002-0398-5. Epub 2002 Nov 9.

Reference Type BACKGROUND
PMID: 12582808 (View on PubMed)

Anglen JO, Apostoles S, Christensen G, Gainor B. The efficacy of various irrigation solutions in removing slime-producing Staphylococcus. J Orthop Trauma. 1994 Oct;8(5):390-6. doi: 10.1097/00005131-199410000-00004.

Reference Type BACKGROUND
PMID: 7996321 (View on PubMed)

Malten KE, den Arend JA. Irritant contact dermatitis. Traumiterative and cumulative impairment by cosmetics, climate, and other daily loads. Derm Beruf Umwelt. 1985;33(4):125-32.

Reference Type BACKGROUND
PMID: 4042875 (View on PubMed)

Dormans JP, Fisher RC, Pill SG. Orthopaedics in the developing world: present and future concerns. J Am Acad Orthop Surg. 2001 Sep-Oct;9(5):289-96. doi: 10.5435/00124635-200109000-00002.

Reference Type BACKGROUND
PMID: 11575908 (View on PubMed)

Charles Court-Brown, Margaret McQueen, Paul Tornetta III. Trauma. 1st ed. Philadelphia: Lippincott Williams and Wilkins, 2006.

Reference Type BACKGROUND

Anglen JO. Wound irrigation in musculoskeletal injury. J Am Acad Orthop Surg. 2001 Jul-Aug;9(4):219-26. doi: 10.5435/00124635-200107000-00001.

Reference Type BACKGROUND
PMID: 11476531 (View on PubMed)

Khatod M, Botte MJ, Hoyt DB, Meyer RS, Smith JM, Akeson WH. Outcomes in open tibia fractures: relationship between delay in treatment and infection. J Trauma. 2003 Nov;55(5):949-54. doi: 10.1097/01.TA.0000092685.80435.63.

Reference Type BACKGROUND
PMID: 14608171 (View on PubMed)

Bhandari M, Guyatt GH, Swiontkowski MF, Schemitsch EH. Treatment of open fractures of the shaft of the tibia. J Bone Joint Surg Br. 2001 Jan;83(1):62-8. doi: 10.1302/0301-620x.83b1.10986.

Reference Type BACKGROUND
PMID: 11245540 (View on PubMed)

Bhandari M, Tornetta P 3rd, Sprague S, Najibi S, Petrisor B, Griffith L, Guyatt GH. Predictors of reoperation following operative management of fractures of the tibial shaft. J Orthop Trauma. 2003 May;17(5):353-61. doi: 10.1097/00005131-200305000-00006.

Reference Type BACKGROUND
PMID: 12759640 (View on PubMed)

Spencer J, Smith A, Woods D. The effect of time delay on infection in open long-bone fractures: a 5-year prospective audit from a district general hospital. Ann R Coll Surg Engl. 2004 Mar;86(2):108-12. doi: 10.1308/003588404322827491.

Reference Type BACKGROUND
PMID: 15005929 (View on PubMed)

Anglen JO. Comparison of soap and antibiotic solutions for irrigation of lower-limb open fracture wounds. A prospective, randomized study. J Bone Joint Surg Am. 2005 Jul;87(7):1415-22. doi: 10.2106/JBJS.D.02615.

Reference Type BACKGROUND
PMID: 15995106 (View on PubMed)

Burd T, Christensen GD, Anglen JO, Gainor BJ, Conroy BP, Simpson WA. Sequential irrigation with common detergents: a promising new method for decontaminating orthopedic wounds. Am J Orthop (Belle Mead NJ). 1999 Mar;28(3):156-60.

Reference Type BACKGROUND
PMID: 10195838 (View on PubMed)

Petrisor B, Jeray K, Schemitsch E, Hanson B, Sprague S, Sanders D, Bhandari M; FLOW Investigators. Fluid lavage in patients with open fracture wounds (FLOW): an international survey of 984 surgeons. BMC Musculoskelet Disord. 2008 Jan 23;9:7. doi: 10.1186/1471-2474-9-7.

Reference Type BACKGROUND
PMID: 18215287 (View on PubMed)

Anglen J, Apostoles PS, Christensen G, Gainor B, Lane J. Removal of surface bacteria by irrigation. J Orthop Res. 1996 Mar;14(2):251-4. doi: 10.1002/jor.1100140213.

Reference Type BACKGROUND
PMID: 8648503 (View on PubMed)

Ware J Jr, Kosinski M, Keller SD. A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Med Care. 1996 Mar;34(3):220-33. doi: 10.1097/00005650-199603000-00003.

Reference Type BACKGROUND
PMID: 8628042 (View on PubMed)

Brooks R, Rabin RE, de Charro F. The measurement and valuation of health status using EQ-5D: a European perspective. Kluwer Academic Publishers, 2003.

Reference Type BACKGROUND

Rabin R, de Charro F. EQ-5D: a measure of health status from the EuroQol Group. Ann Med. 2001 Jul;33(5):337-43. doi: 10.3109/07853890109002087.

Reference Type BACKGROUND
PMID: 11491192 (View on PubMed)

Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol. 1992 Oct;13(10):606-8. No abstract available.

Reference Type BACKGROUND
PMID: 1334988 (View on PubMed)

Owens BD, White DW, Wenke JC. Comparison of irrigation solutions and devices in a contaminated musculoskeletal wound survival model. J Bone Joint Surg Am. 2009 Jan;91(1):92-8. doi: 10.2106/JBJS.G.01566.

Reference Type BACKGROUND
PMID: 19122083 (View on PubMed)

Bhandari M, Adili A, Schemitsch EH. The efficacy of low-pressure lavage with different irrigating solutions to remove adherent bacteria from bone. J Bone Joint Surg Am. 2001 Mar;83(3):412-9. doi: 10.2106/00004623-200103000-00014.

Reference Type BACKGROUND
PMID: 11263646 (View on PubMed)

Strube DD, Nicoll G. The irritancy of soaps and syndets. Cutis. 1987 Jun;39(6):544-5.

Reference Type BACKGROUND
PMID: 3608584 (View on PubMed)

Simion FA, Rhein LD, Morrison BM Jr, Scala DD, Salko DM, Kligman AM, Grove GL. Self-perceived sensory responses to soap and synthetic detergent bars correlate with clinical signs of irritation. J Am Acad Dermatol. 1995 Feb;32(2 Pt 1):205-11. doi: 10.1016/0190-9622(95)90127-2.

Reference Type BACKGROUND
PMID: 7829704 (View on PubMed)

Bhandari M, Adili A, Lachowski RJ. High pressure pulsatile lavage of contaminated human tibiae: an in vitro study. J Orthop Trauma. 1998 Sep-Oct;12(7):479-84. doi: 10.1097/00005131-199809000-00009.

Reference Type BACKGROUND
PMID: 9781772 (View on PubMed)

Bhandari M, Schemitsch EH, Adili A, Lachowski RJ, Shaughnessy SG. High and low pressure pulsatile lavage of contaminated tibial fractures: an in vitro study of bacterial adherence and bone damage. J Orthop Trauma. 1999 Nov;13(8):526-33. doi: 10.1097/00005131-199911000-00002.

Reference Type BACKGROUND
PMID: 10714777 (View on PubMed)

Dirschl DR, Duff GP, Dahners LE, Edin M, Rahn BA, Miclau T. High pressure pulsatile lavage irrigation of intraarticular fractures: effects on fracture healing. J Orthop Trauma. 1998 Sep-Oct;12(7):460-3. doi: 10.1097/00005131-199809000-00005.

Reference Type BACKGROUND
PMID: 9781768 (View on PubMed)

Bhandari M, Schemitsch EH. High-pressure irrigation increases adipocyte-like cells at the expense of osteoblasts in vitro. J Bone Joint Surg Br. 2002 Sep;84(7):1054-61. doi: 10.1302/0301-620x.84b7.12532.

Reference Type BACKGROUND
PMID: 12358372 (View on PubMed)

Adili A, Bhandari M, Schemitsch EH. The biomechanical effect of high-pressure irrigation on diaphyseal fracture healing in vivo. J Orthop Trauma. 2002 Jul;16(6):413-7. doi: 10.1097/00005131-200207000-00008.

Reference Type BACKGROUND
PMID: 12142830 (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)

FLOW Investigators; Petrisor B, Sun X, Bhandari M, Guyatt G, Jeray KJ, Sprague S, Tanner S, Schemitsch E, Sancheti P, Anglen J, Tornetta P, Bosse M, Liew S, Walter S. Fluid lavage of open wounds (FLOW): a multicenter, blinded, factorial pilot trial comparing alternative irrigating solutions and pressures in patients with open fractures. J Trauma. 2011 Sep;71(3):596-606. doi: 10.1097/TA.0b013e3181f6f2e8.

Reference Type DERIVED
PMID: 21378581 (View on PubMed)

Other Identifiers

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05-299

Identifier Type: -

Identifier Source: org_study_id

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