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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
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  • 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

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  • 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)
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