What solution is recommended for wound cleansing before suturing?

Wound Cleansing Solutions Before Suturing

For wound cleansing before suturing, sterile saline solution without additives is the recommended solution as it effectively removes debris while not interfering with the normal healing process. 1, 2

Evidence-Based Wound Cleansing Protocol

Primary Cleansing Solution

• Use sterile saline solution for wound irrigation before suturing 1, 2
• Ensure thorough irrigation with sufficient volume (100-1000 mL) to remove all visible debris 2
• Apply adequate pressure during irrigation to effectively clean the wound without causing tissue trauma 2

Alternative Cleansing Options

• Clean potable tap water is an acceptable alternative to saline, particularly in community settings 2, 3
  • Tap water has been shown to be safe and cost-effective for wound cleansing 4
  • May be particularly useful in resource-limited settings
• Warm water is preferable to cold water as it provides more comfort while being equally effective 2

What to Avoid

• Avoid additives such as soap or antiseptics in irrigation solutions as they provide no additional benefit and may impair healing 1
• There is insufficient evidence to support routine use of povidone-iodine for wound irrigation before closure 1
• Hydrogen peroxide, while sometimes used, has limited evidence for routine use before suturing 5

Technique for Optimal Wound Cleansing

1. Irrigate the wound thoroughly with sterile saline until all visible debris is removed 2
2. Use sufficient volume (100-1000 mL) depending on wound size and contamination 2
3. Apply appropriate pressure during irrigation - vigorous enough to remove debris but gentle enough to avoid tissue trauma 1
4. Ensure complete removal of foreign material and cellular debris 1

Important Considerations

• The goal of wound cleansing is to physically remove foreign material, cellular debris, surface bacteria, and body fluids 1
• Vigorous irrigation must be balanced against the risk of driving bacteria deeper into the wound 1
• For open fractures and traumatic wounds, simple saline solution without additives has strong evidence supporting its use 1
• The AAOS Clinical Practice Guideline provides strong recommendation for initial management of open wounds using simple saline solution without additives 1

Practical Application

For routine wound preparation before suturing:

1. Clean the surrounding skin with an appropriate antiseptic
2. Irrigate the wound itself with sterile saline
3. Use adequate volume and pressure to ensure thorough cleaning
4. After cleaning, proceed with suturing using standard aseptic technique

This approach balances effective wound cleansing with preservation of the wound environment to promote optimal healing and prevent infection.