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Some Principles Regarding Wound Debridement

By Michael White


In the event that the underlying tissues are exposed to the external environment, a wound is created. This can happen when a surgeon intentionally makes an incision in the skin for the purpose of accessing internal structures. Such wounds are generally referred as surgical wounds. When the respiratory, genitourinary or gastrointestinal tracts are entered, the wound is said to be contaminated and need to undergo wound debridement, even though there may be no signs of infection. Clean, contaminated surgical wounds have signs of infection.

When a surgical wound is complicated by foreign bodies such as bullets, wood or metal, the affected tissues are said to be dirty since they usually ooze large amounts of pus among others signs of infection. This can happen acutely if the foreign body was originally full of harmful bacteria. In other circumstances, it may take a while for a dirty environment to occur as bacteria take time to accumulate. Removal of the foreign object needs to be timely so as to minimize the chances of dirty wound creation.

It takes time for necrotic tissues to spread and cover larger areas. It also takes some time for a bad smell to be detected. One does not need to wait for such extensive complications to set in for them to seek intervention. Infection prevention and rapid healing should begin with the person who has sustained the injury at home or in a work setting. One should ensure that the wound is tentatively dressed to minimise bacterial entry. They should then seek medical care as soon as possible in which case measures such as administration of antibiotics as prophylaxis.

When normal tissues are exposed to the environment, they are at risk of getting infected by the many bacteria that exist in nature. Once bacteria get in contact with vulnerable skin, the body immediately mounts an immune response. The cells responsible for fighting infection (white blood cells) are transported to the site of bacteria. These cells release substances that are toxic to the survival of the bacteria inside the body. In the event that the immune system fails to correct the anomaly, pus begins to form and the tissues begin to decay.

There are various ways in which wounds can be debrided. A common method is to mechanically get rid of debris by use of appropriate surgical tools. This is normally done under local or general anaesthesia based on how much tissue needs to be removed. In other instances, chemicals are used to breakdown abnormal tissues and isolate them from the normal tissues.

In isolated situations, larvae from maggots can be utilized. The area to be debrided is marked and larvae deposited there. The main goal is to ensure that all bacteria are consumed by the maggots thus preventing systemic spread.

The area is usually dressed after every debridement session to prevent further exposure to microbes and to provide some time for it to heal. Grafting should be considered for wounds that are extremely extensive. This may mean that a plastic and reconstructive surgeon be incorporated into the management team.

The important thing to remember is that all wounds need to be given maximum attention to prevent complications. Wounds may take longer to heal for patients with underlying diseases such as diabetes and cancer. Sterility needs to be given priority when managing any break in skin to expedite the healing process.




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