Wound Irrigation Prior to Closure During Routine Upper-Extremity Surgery: Is There a Difference in Wound Complications?

Background: Presently, there is no consensus within the field of orthopedics on whether irrigation prior to wound closure in routine upper-extremity surgery reduces wound complications. Therefore, preclosure wound irrigation could provide time and cost savings. The aim of this study was to evaluate the effectiveness of wound irrigation in routine upper-extremity procedures.

Methods: We conducted a retrospective review of adult patients undergoing routine upper-extremity surgery at a single institution from 2013 to 2022. Patients were included if they underwent soft tissue upper extremity surgery. Patients were excluded for having concomitant lacerations, penetrating injuries, open fractures, or unknown irrigation technique. Our primary outcome was comparison of the rate of wound complications based on whether irrigation was used. Multivariable logistic regression was additionally used to determine whether irrigation prior to closure was associated with a lower incidence of postoperative wound complications independent of potential confounders.

Results: We included 1425 patients. The mean age was 55.2 ± 16 years and 65% were female. The incision was irrigated prior to closure in 65% of surgeries. Wound complications occurred in 2.9% of patients (n = 41). On bivariable analysis, irrigation prior to closure was not associated with a decreased incidence of wound complications (3.5% vs 1.8%, P = .070). When adjusting for age, sex, BMI, operative time, history of prior surgery, diabetes, tobacco use, corticosteroid use, and immunosuppressant use, the employment of irrigation prior to wound closure was not associated with lower odds of wound complications in either bivariable (OR: 1.99, 95% CI 0.94-4.19, P = .07) or multivariable (OR: 1.88, 95% CI 0.88-4.04, P = .08) analysis.

Conclusion: Use of irrigation prior to wound closure was not associated with a difference in the odds of postoperative wound complications. Surgeons should consider forgoing irrigation prior to closure to increase operating room efficiency and provide cost savings to the patients and payers.