Cleaning wounds before surgery with soap and water is actually less effective than using saline water, report researchers.

The findings could lead to significant cost savings, particularly in developing countries where open fractures are particularly common.

As part of the study, 2,400 people with open arm or leg fractures had their wounds cleaned with either soap and water or a saline water solution, and one of three different levels of water pressure. Patients were monitored to see who would need to have an additional operation within 12 months because of infection or problems with wound healing.

The researchers found that very low water pressure was an acceptable, low-cost alternative for washing out open fractures, and that the reoperation rate was higher in the group that used soap.

Debridement Controversial

Says Mohit Bhandari, principal investigator and a professor of surgery for the Michael G. DeGroote School of Medicine at McMaster University.

“There has been a lot of controversy about the best way to clean the dirt and debris from serious wounds with bone breaks.

All wounds need to be cleaned out— a process known as debridement— but evidence shows that cleaning wounds with soap was not better than just water, which was unexpected.”

Adds coauthor Edward Harvey, chief of orthopedic trauma at the McGill University Health Centre and a professor of surgery at McGill University:

“These findings may have important implications for the care of patients with open fractures worldwide since developing countries deal with a disproportionate number of cases.

Most of the time we were using soap and water with a high pressure delivery system to clean the wound, but now we don’t, and that makes the best practice much cheaper.”

The study involved patients across 41 sites in the United States, Canada, Australia, Norway, and India. The majority of patients were men in their 40s with a lower extremity fracture, and the most common reason for the injury was a motor vehicle accident.

The researchers add that their findings may be particularly relevant for low- and middle-income countries where 90 percent of road traffic fatalities, and probably a similar proportion of open fractures, occur, according to the World Health Organization.

The FLOW Investigators A Trial of Wound Irrigation in the Initial Management of Open Fracture Wounds NEJM DOI: 10.1056/NEJMoa1508502

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