Background: Pulsed lavage is commonly used for surgical wound irrigation to reduce bacterial burden, yet concerns remain regarding pressure-dependent tissue injury and environmental pathogen dissemination. This review evaluates the balance between decontamination efficacy and potential harm. Methods: Eighteen studies published between 2004 and 2025 were reviewed, including systematic reviews and meta-analyses, randomised and non-randomised clinical studies, observational cohorts, experimental animal and ex-vivo studies. Outcomes included surgical site infection (SSI) rates, bacterial reduction, tissue injury, and infection control risks. Results: Pooled clinical evidence demonstrates that pulsed lavage is associated with reduced SSI rates, particularly in abdominal and prolonged procedures. A 2021 systematic review1 and a subsequent 2025 meta-analysis2 reported clinically meaningful reductions in SSI, with robust effect estimates in abdominal surgery. Observational studies also describe immediate bacterial load reduction. In contrast, experimental and animal studies highlight important trade-offs: high-pressure irrigation (>20 psi) is consistently associated with soft tissue injury, including muscle necrosis, dystrophic calcification, and deeper bacterial penetration. Conclusion: Pulsed lavage can reduce SSI risk in selected surgical contexts, but its benefits are highly dependent on pressure control, infection control practices, and careful case selection. Gravity irrigation remains a reasonable alternative where equivalent outcomes are expected. References: 1.Bath, M.F., et al., Does pulsed lavage reduce the risk of surgical site infection? A systematic review and meta-analysis. Journal of Hospital Infection, 2021. 118: p. 32-39. 2.Adam, Y.A., et al., Effect of Pulsed Lavage on Surgical Site Infection in Abdominal Surgery: A Systematic Review and Meta-Analysis. The American Surgeon™, 2025. 91(9): p. 1503-1510.