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4Treatment - initial surgery for fracture wound infection

Wound after débridement

After débridement, the surgical site should be thoroughly irrigated with normal saline solution to reduce the bacterial population. The use of pulsatile lavage has been questioned as the water jet might transport bacteria deeper into the soft tissue. In cases with large amounts of dead tissue, or grossly purulent wounds, repeated surgical clearances are indicated. Deciding what tissue to remove and what tissue to retain is the essential challenge of débridement. Such decision-making is learned from experienced surgeons and by practice. Common errors are failure to remove enough compromised tissue, and/or to do so in a way that injures the retained tissue. An organized approach that proceeds in orderly steps through tissue levels is required. Any non-viable skin is excised. The incision should be extended, as necessary, for adequate exposure of the whole infected zone. The depths of the wound are then exposed, and must include all of the previous surgical exposure. Any extension of hematoma, pus, or necrotic tissue, should be explored fully.