WOUND TOILET AND SURGICAL DEBRIDEMENT

• Thoroughly clean the wound with normal saline or sterile water.
• It is important to use a large volume of fluid and pressure to remove all visible dirt and debris from a wound
• Use a large syringe for irrigation. Attach a 16 or 19 gauge needle or soft IV catheter to generate pressure.
• Gentle handling of tissues to minimize bleeding, additional trauma
• Control residual bleeding with compression, ligation, cautery
• Dead or devitalized muscle is dark in color, soft, easily damaged; does not contract when pinched
• Dead tissue does not bleed when cut

Wash wound with large quantities of soap and boiled water for 10 minutes, then irrigate with saline; prep skin with antiseptic (A) Debride wound meticulously to remove loose foreign material, use surgical techniques to cut away damaged, dead tissue Excise only very thin margin of skin from wound edge (B)

DEBRIDEMENT

Systematically perform wound toilet, surgical debridement; initially to superficial tissue layers, subsequently deeper layers (C and D) With scalpel or dissecting scissors, remove all adherent foreign material along with a thin margin of underlying tissue, irrigate Continue cycle of surgical debridement, saline irrigation until wound is completely clean

WOUND TOILET AND SURGICAL DEBRIDEMENT

• Leave wound open after debridement to allow for healing by secondary intention
• Pack lightly with damp saline gauze, cover packed wound with dry dressing
• Change packing, dressing daily - more often if outer dressing becomes damp with blood, other body fluids
• Large defects will require closure with flaps or skin grafts but may be initially be managed with saline packing

PREVENTION OF WOUND INFECTIONS

• Restore breathing, blood circulation as soon as possible after injury
• Warm victim; at earliest opportunity provide high-energy nutrition, pain relief
• Perform wound toilet, debridement as soon as possible (within 8 hours if possible)
• Respect universal precautions
• Antibiotic prophylaxis for deep or penetrating wounds (dirty stick, knife) and wounds older than 12 hours

Factors that affect wound healing and infection potential

Patient

• Age
• Underlying illnesses or disease: anemia, diabetes, immune deficient

Patient

• Organ or tissue injured
• Extent of injury
• Nature of injury (laceration less complicated than crush injury)
• Contamination or infection
• Time between injury and treatment (sooner is better)