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4Débridement and irrigation

It is important to perform a thorough surgical débridement in an organized manner. Starting with the skin, each layer is debride

General principles of debridement

It is important to perform a thorough surgical débridement in an organized manner. Starting with the skin, each layer is debrided systematically. One can imagine a clock face; wound débridement starts at the 12 o’clock position and continues in a clockwise manner around the circumference of the wound. This is repeated for each layer down to the level of the bone. Necrotic tissue is removed and only viable tissue is left behind. The exception is skin, where none is removed unless obviously necrotic.
The quality of the muscle tissue is assessed using the classic 4 C’s:

  • Color (red or brown)
  • Consistency (how does the muscle feel)
  • Capillary Circulation (does it bleed?)
  • Contractility (responds to pinch or electro-cautery)