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Debridement
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Debridement

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  • 1. Removal of non viable tissueRemoval of foreign body-organic and inorganic = Preserving all that is viable
  • 2. All non surgical wounds need to be debrided,regardlessof their sizeThe size of the wound is no index of the nature of theinjury belowWounds are contaminated or dirty( CDC criteria)Debridement is a true emergency,repair (exceptrevascularisation)is not
  • 3. ? non viable tissue?Avulsed skin flaps Deeply abraded skin Contused muscle ? Free bone fragments ?
  • 4. Prerequisites of debridementGood analgesia/anaesthesia Bloodless operative field Surgical excision
  • 5. Getting ready for debridementAnaesthesia/analgesiaLimb elevation for exsanguinationTourniquet inflationWash/ScrubPaint
  • 6. With what do you wash?Normal salineTap waterBoiled and cooled waterAntiseptic solutionPulsed jet lavage wound irrigation-15 psi
  • 7. The quality of surgical result is almost always related tothe quality of debridement
  • 8. Inadequate debridement Depth Surface Deep infection Sub flap collection Suture line disruptionRaw area Secondary procedures Increased hospitalization
  • 9. 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
  • 10. The decision regarding skin closure or cover is madeonly at the conclusion of debridement
  • 11. A judicious amputation can be considered an extensionof debridement
  • 12. A judicious amputation can be considered an extensionof debridement
  • 13. Debridement in wounds that present lateAppearance of granulation tissueExposed bone which may be deadEstablishment of infection
  • 14. 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
  • 15. Always remember fasciotomy-an extension of debridement Look forNail bed capillary refill,pulp turgor,compartment pressure Forget peripheral doppler and spiral CT scan