What is Debridement?

Debridement is a surgical method that removes foreign bodies from open wounds, removes necrotic, inactivated, or heavily contaminated tissue, sutures the wound, minimizes contamination and even becomes a clean wound, achieving first-stage healing, which is beneficial to the injured site Surgical methods for functional and morphological recovery.

Basic Information

Debridement anesthesia

Local anesthesia.

Indications for debridement

Debridement should be performed on wounds within 1.6 to 8 hours.
Debridement is still feasible for wounds between 2.8 and 24 hours, but whether or not a primary suture should be performed depends on the wound condition.

Debridement contraindications

1. Patients with hemorrhagic shock should first correct the shock.
2. The vital organs with severe life-threatening injuries are the first to be rescued, and debridement should not be performed immediately.

Debridement procedure

1. Wound cleaning and disinfection: Use sterile dressings to cover the wound, clean the skin around the wound, and hair should be shaved. Oil stains can be removed with gasoline, washed with soapy water, and finally washed with distilled water. After the surrounding skin is cleaned, the wound surface is washed. Rinse briefly with saline, then with 1% hydrogen peroxide, and then repeatedly with saline. After the wound is washed, the skin is disinfected. Currently, iodoform (iodine) disinfectant is commonly used, which has little irritation to the skin and can be used for wound washing. After disinfection, sterilize as usual.
2. Debridement: Debridement should be performed after full exposure. If necessary, the wounds should be enlarged. The wounds of the extremities can be cut along the long axis of the limb.
3. Removal of inactivated tissues and foreign bodies: Necrotic and inactivated tissues in the wound should be excised, and the operation should be performed from shallow to deep according to the anatomical level of the tissue. After the necrotic tissue is removed, the wound should be completely stopped to prevent new hematoma from forming. The foreign body in the wound should be removed as much as possible, and some small metal foreign bodies should be removed from the wounded path without affecting the function.
4. Drainage: Drainage should be placed in deep wounds. Rubber pads, rubber tubes, etc. can be used as the drainage material. The sheet-shaped drainage material can draw the liquid (blood, exudate) in the wound cavity to the dressing. Bags, sometimes with negative pressure or flushing, for more adequate drainage.
5. Suture: Suture the wound immediately after debridement, which is called first-stage suture. It is suitable for wounds with light pollution and rich blood supply, such as head and face injuries. Thoracic and abdominal cavity, joint cavity should also be closed with a period of suture. Nerve, muscle and vascular tissue should be covered with skin. Heavily contaminated wounds, infected wounds, and firearm wounds are generally not sutured in the first stage, but should be sutured after the infection is controlled.

Debridement complications

1. Severe open fracture, bone fragments may be lost during debridement, resulting in increased bone defects.
2. Open joint injuries can lead to articular cartilage defects.
3. Incomplete debridement can lead to infection.

Debridement considerations

1. Wound cleaning is an important step in debridement. It must be repeatedly washed with a large amount of physiological saline, and the wound must be cleaned before debridement. Local anesthesia can only be anesthetized after washing the wound.
2. During debridement, it is necessary to completely remove the tissue that has lost vitality, and to take care of and retain the living tissue as much as possible, so as to avoid wound infection and promote healing and preservation.
3. Tissue suture must avoid too much tension to avoid ischemia or necrosis.

Nursing after debridement

1. For patients with bone or joint injury or major debridement of nerves, tendons, and blood vessels, postoperative fixation and braking should be assisted and guided to raise the affected limb and reduce swelling.
2. Observe wound drainage. If there is too much bleeding, check the wound in time and stop bleeding. For drainage with rubber tube or rubber sheet, it is removed 24 hours after operation.
3. Inject tetanus antitoxin 1 500 U within 24 hours after injury, and use antibiotics according to the doctor's advice according to the situation.
4. Instruct patients to do early activities of injured limbs to promote functional recovery.