I wish to criticize the fact that wound irrigation with infusion catheters or button cannulas, which are inserted into the full depth of the bite wound in order to remove foreign bodies and pathogens (1) is described as an apparently common method and in such a neutral fashion. Only “irrigation under pressure is inadvisable”. It would have been much better to request immediate surgical necrosectomy for any bite wound, if needed after referral to a specialized hospital (2), and to present any cannulation or irrigation as no longer recommended.
It amounts to helpless wishful thinking to believe that injecting fluids with a syringe will help expel anything from the wound—especially not foreign bodies or pathogens. Injecting fluids will naturally spread the infection into tissue spaces, tendon sheaths, joint capsules, and so on. Even those in favor of irrigation admit this risk, and they warn against it without having any idea how it might be prevented (3, 4). Surgical debridement has been confirmed as a sensible option, but irrigation never has. Almost all patients who present with purulent bite wounds after 3–4 days for the purposes of revision in a scenario of manifest infection have previously received irrigation.
Let us finally put a stop to half-hearted irrigation.
References
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