Surgical Irrigation: An Exploration

Surgeons have the freedom to choose the solution used by the operating team to irrigate a patient's wound or incision. The purpose of irrigation is to prevent infection as much as possible during the post-op recovery period, and can often help during surgery when skeletal or tissue debris can impede a surgeon's vision. For the most part, surgeons use an antibacterial solution that consists mostly of saline solution. Saline is simply a homogenous mixture of purified water and NaCl (Salt), and most saline solutions are 90% NaCl.

Beyond saline, which is more commonly used in nasal irrgation or to clean ear piercings, antibiotic additives are added to the average surgical irrigation solution. A common example of an antibiotic additive is Bacitracin, a mixture of cyclicly related polypeptides originally isolated in the 1940s. Bacitracin, much like penicillin, interferes with the dephosphorylation of the C₅₅-isoprenyl pyrophosphate, a molecule that carries the building-blocks of the bacterial cell wall outside of the inner membrane to help prevent infection through the cell wall.

While many studies show that bacitracin and saline solution does lower the rate of infection significantly when used on an open wound, such as a study done in a lab in Turkey with three sets of rats, one of which was treated with bacitracin after an open wound, some treated with 50% bacitracin solution, and one control with pure saline, which revealed 2 out of 13 rats had no infection in the first group and 13 out of 13 did in the control (International Journal of Impotence Research 2000, http://www.ncbi.nlm.nih.gov/pubmed/1852419), infection still remains a rampant post-op hazard.

For this reason, neuro and spine surgeons have experimented with the use of betadine and peroxide in their saline irrigation, despite some studies that show that betadine may be toxic to some groups of cells. A study done in 2009 in Siena, Italy, revealed that when using irrigation in spinal surgery that contained 1/3 H202, 1/3 Betadine and 1/3 Saline, 0 infections came about, a better result than the 7 found when using antibiotic irrigation the prior year (http://www.ncbi.nlm.nih.gov/pubmed/21258810).

Today, increasing numbers of surgeons have begun to use betadine or povidoneiodine in their intrasurgery irrigation. Betadine and Povidoneiodine are widely used antiseptic and disinfectant agents. They can eradicate most pathogens, included MRSA, and no bacterial resistance has been reported. However, it has been thought to be toxic to osteoblasts and fibroblasts, possibly retarding bone and wound healing. But, because of iodine solution's success in preventing infection, this concept is now challenged.