Removal of non viable tissueRemoval of foreign body-organic and inorganic

=

Preserving all that is viable

All non surgical wounds need to be debrided,regardless

of their size

The size of the wound is no index of the nature of the

injury below

Wounds are contaminated or dirty( CDC criteria)

Debridement is a true emergency,repair (exceptrevascularisation)is not

Contused muscle

? non viable tissue?

Deeply abraded skinAvulsed skin flaps

? Free bone fragments ?

Prerequisites of debridement

Good analgesia/anaesthesia

Bloodless operative field

Surgical excision

Getting ready for debridement

Anaesthesia/analgesiaLimb elevation for exsanguinationTourniquet inflationWash/ScrubPaint

With what do you wash?

Normal salineTap waterBoiled and cooled waterAntiseptic solution

Pulsed jet lavage wound irrigation-15 psi

The quality of surgical result is almost always related to

the quality of debridement

Surface

Raw area

Suture line disruption

DepthInadequate debridement

Increased hospitalizationSecondary procedures

Sub flap collection

Deep infection

Skin -needs dermal supplySubcutaneous tissue-remove dead fatDeep fascia-preserve if attached to overlying skinMuscle –nutrient for anaerobic bacteriaTendon-maintain continuity if possibleNerve-maintain continuity if possibleVessel-must bleed,no thrombusBone-free bone fragments

The decision regarding skin closure or cover is made

only at the conclusion of debridement

A judicious amputation can be considered an extension

of debridement

A judicious amputation can be considered an extension

of debridement

Debridement in wounds that present late

Appearance of granulation tissueExposed bone which may be deadEstablishment of infection

If you do have to err do you debride more or less?

“Debride more”Conservative approach is excusable for surface tissues but thenthey are the easy ones to replaceStructures on volar side are more importantWrist extensors and FDP/FPL are more importantMPJ of fingers and Thumb CMC is more important

Always remember fasciotomy-an extension of debridement

Look for

Nail bed capillary refill,pulp turgor,compartment pressure

Forget peripheral doppler and spiral CT scan