Does pulsatile lavage increase wound healing rate in those with spinal cord injury?

Posted on 10th January 2014 by Kaitlin Luffman

I have a keen interest in potentially working with patients who have wounds when I graduate from physical therapy school. We have yet to learn much regarding wounds in our course work, but it is coming soon! I was interested in researching different types of treatments that can enhance the healing rate of wounds in order to decrease a patient’s length of stay in the hospital. Pulsatile lavage is typically used in wounds to debride (or clean out) the wound to prevent further infection and allow the healing process to take place appropriately. Think of it (pulsatile lavage) as a water gun with a suction attached– Let me explain: There is a water gun that has a saline solution attached. This water gun is placed in/around the wound and held there. As the trigger is pressed a saline mixture flows into the wound to clean the area and then the suction that is attached to this same water gun pulls the saline and debris out of the wound into a special canister. This is typically a daily treatment used in combination with wound dressing changes to provide an “optimal” environment for wound bed healing. Below is a synopsis of the article and why this article could be important in potential physical therapy care of wound treatment.

Why is this article important?

This article was one of the first attempts at understanding the effectiveness of pulsatile lavage in advancing healing rates of stage III or IV pelvic wounds in those with spinal cord injuries (SCI). This study was conducted in a Veteran’s Administration Hospital, where spinal cord injuries are a common diagnosis among patients in the hospital. Due to a lack of sensation and motor control from a SCI, the patient typically lies in bed for most of the day, which can lead to pressure ulcers (or wounds) from skin and tissue break down on their back-side. Enhancing healing rates of these wounds provides better outcomes for the patient, first and fore-most, but also reduces hospital length of stay and costs. Therefore, finding treatments that are effective at increasing healing rates of wounds are always useful.

What did they do in the study?

There were 28 participants who all had stage III or IV pelvic pressure ulcers and a diagnosis of SCI. These 28 participants were divided into 2 groups and either received a sham pulsatile lavage (fake treatment/no treatment) or low-pressure pulsatile lavage. Each participant received “standard wound care” and pressure relief with a low-air-loss mattress and turning every 2 hours, regardless of what group they were allocated to. This “standard wound care” was different for each participant as the physician who was overseeing each of their care determined the type of standard wound care they received (other than the pulsatile lavage treatment). The participants were not aware of which group they were in. They also could not find out during treatment as they were turned on their side and could not see the treatment while it was going on, nor could they feel it due to loss of sensation in that area from the SCI. A requirement to participate in the study was to have loss of sensation over the area of the wound.

The same nurse performed all of the treatments – sham or low-pressure pulsatile lavage. Another nurse performed all of the measurements of the wound size to monitor for change, which would later determine the healing rate of the wound. The wound was measured using a standard paper tape ruler to determine the length, width and depth of the wound, and was measured volumetrically by closing the wound and filling it with a liquid to determine a volumetric measurement. Treatments took place daily for 3 weeks and measurements were taken once a week. Baseline measurements were taken prior to any treatment, and then one measurement at each week interval (for 3 weeks), for a total of 4 measurements per participant.

What did they find?

This study found that the use of low-pressure pulsatile lavage in combination with standard wound care did advance the healing rate of stage III and IV pressure ulcers in patients with SCI. The study authors did point out that the reasons behind the enhanced healing rate are unknown. However, there was a significant difference in the healing rate and wound size of those who received the low-pressure pulsatile lavage treatment and those who did not.

A major drawback to the study

The authors decided only to investigate the effects of pulsatile lavage treatment on “clean” wounds. In my experience working with patients who have wounds, pulsatile lavage was typically used as a debridement treatment for necrotic wounds- meaning: it was used in the cleaning process of the wound, not simply to enhance the healing rate. I think this study is a good founding process for how pulsatile lavage could be used in different ways, but it does not explain its effectiveness in debridement of wounds.

Take home message

I would use this study in combination with other studies to decide whether pulsatile lavage is an effective treatment for a particular patient I may see. It is important to find treatments that assist in the healing rate of wounds, so the patient can return to their prior level of function more rapidly. I believe pulsatile lavage could be an effective treatment in enhancing the rate of healing of a wound regardless if the wound is necrotic or clean.

References:

Chester H. Ho, Toula Bensitel, Xiaofeng Wang and Kath M. Bogie. Pulsatile Lavage for the Enhancement of Pressure Ulcer Healing: A Randomized Controlled Trial. PHYS THER. 2012; 92:38-48.

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