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Historical Origins and Current Concepts of Wound Debridement
  1. HC Guthrie, Trauma and Orthopaedic Specialty Training Registrar1 and
  2. Colonel JC Clasper, L/RAMC, Defence Professor Trauma and Orthopaedics2
  1. 1South-West Thames Rotation, London Deanery
  2. 2Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham; Consultant Trauma and Orthopaedic Surgeon, MDHU Frimley Park
  1. Frimley Park Hospital, Portsmouth Road, Camberley, Surrey GU16 7UJ. 01276 526447 01276 604457 jonclasper{at}aol.co.uk

Abstract

In the late 18th Century wound debridement consisted of incision of skin and deep fascia to release the swelling associated with ballistic injury, however extremity war wounds were more usually managed non-operatively or by amputation. During the First World War debridement was redefined to include excision of all non-viable and foreign material. In the modern era it has been proposed that wounds contain a zone of injured tissue which is not obviously non-viable at the initial debridement. Debridement which preserves this tissue has been described as marginal debridement. Wounds sustained in close proximity to explosions have an extensive zone of injury. Preservation of traumatised tissue may be beneficial in terms of limb salvage and limb reconstruction. Equally the complexity and contamination of these wounds, as well as the physiological frailty of the casualty, may make complete debridement in one sitting an unachievable goal. Where traumatised tissue has been left during debridement it must be reassessed at around 48 hours in order to reduce the risk of infection. Evacuation timelines and logistic infrastructure currently support serial marginal debridement but in future conflicts this may not be the case.

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