7 4 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • O C T O B E R 2 0 1 8
1. Begin the irrigation after closing the fascia. The goal is to focus
on the subcutaneous layer and remove any loose fat or possibly con-
taminated peritoneal fluid that comes through.
2. Elevate and irrigate downstream. During the procedure, you
want to make sure the head of the operating table is elevated, and that
you have a basin by the wound. This step ensures there is little to no
runoff during the irrigation process. If you just irrigate without the
head of the bed elevated, it's going to run over both sides of the bed
and create a mess — as well as a slip hazard. But by raising the head
up and irrigating downstream, you'll collect almost all of the saline in
that basin.
3. Combine irrigation with massage. You'll want to use voluminous
amounts of saline when you irrigate. Normally about 2 to 5 liters, but
that's just a general guide. You could wind up using a little more, you
could wind up using a little less. During the irrigation process, you'll
want to vigorously massage all the wound margins, too.
4. Don't stop until the fat is all gone. The final step in the process is
critical. The irrigation process isn't complete until you've removed all
devitalized and loose fatty tissue. To ensure you get everything, keep
irrigating until there is no loose fat tissue flooding over the inferior
aspect of the incision(s).
Proven to work
That's all there is to it. The simple irrigation technique is a cheap,
quick and proven way to reduce your chances of a patient getting an
SSI. When you think of all that could go wrong by not adding this 5-
minute step, it's easy to see why irrigation should always be a part of
your closing process.
Plus, it's proven. While there isn't as much research as there
