Cleansing refers to the use of fluid to remove loosely attached cellular debris, surface pathogens, and residual topical agents from the wound surface.12

Debridement refers sharp, mechanical, autolytic or chemical means to remove adherent material from the wound.12 Whirlpool seeks to address the reduction of bacterial bioburden while simultaneously loosening slough and foreign debris with emulsification of adherent fibrin. However, when used in the treatment of extremities, the resulting vascular impact can be one of edema, due in part to the dependent position of the extremity, with a corresponding increase in venous hypertension.41 Physiologically, at the cellular level, cooling, super hydration and maceration occur, with a noted decrease in antimicrobial peptide levels, macrophage and neutrophil presence. Newly

formed granulation tissue is often fragile and easily disrupted. A potential MK0683 order unintended consequence of using WP jets or agitation to dislodge debris, may be the reduction of granulation Small Molecule Compound Library tissue. In addition, there are documented risks for patient cross contamination with the WP proven to be the vehicle.34, 35 and 44 Insubstantial evidence exists to unequivocally support the role of WP therapy in wound healing. Many claims are based in anecdotal accounts.2 Studies lack quality (e.g., no randomization or blinding) and are outdated by over 20 years.2, 30, 31, 32 and 33 Only one recent high quality study mafosfamide demonstrated its benefits over a control with no hydrotherapy,30 however, this study did not compare WP benefits to other modalities.30 Concurrently, a pool of studies associating WP therapy with nosocomial infections

and delayed wound healing exists.2, 34, 35, 36 and 41 Several single-patient-use-WP alternatives are readily available and which have literature support and a documented lower risk of adverse events. PLWV is an example of a technique that has been directly compared with WP therapy and is more efficient for wound cleansing. Other examples include NPWT, compression, moist dressings, and perhaps ultrasound. These are only a few of the technologies available for wound cleansing, disruption of biofilm and debridement. There are some limitations to this report. Some articles regarding WP therapy were inaccessible by online database but were summarized by several systematic reviews herein. Another limitation is the use of articles with data from different types of wounds (e.g., burn wounds, chronic wounds, pressure ulcers, venous leg ulcers). While it is acknowledged that these wounds arise from varied etiologies, nonetheless they progress through the same phases of healing. The conclusions from this report should support its ability to be generalized to all wound types. Limited evidence supporting WP usage exists when contrasting the intended goals and patient physiological response.