Debridement of Muscle

    - debridement was originally described by Napoleon's surgeon Baron Dominique Jean Larrey;
    - non-viable muscle can be identified by the 4 c's (color, consistency, contraction, and circulation);
           - the best indicator of viability is bleeding during debridement;
    - non viable muscle can be identified by its dark color, its mushy consistency, its failure to contract when pinched with forceps, and the absence
              of bleeding from a cut surface;
    - the fascia should be incised parallel parallel to the muscle fibers in both directions;
    - the underlying muscle surrounding the missle tract should be opened in the direction of its fibers to the degree necessary to achieve exposure
              adequate to inspect the tract, remove foriegn bodies, and excise non viable muscle;
    - consider IV fluorescein dye to identify dead tissue;
    - consider second look at 24 to 48 hours


- References:
     - Regional blood flow in skeletal muscle after high-energy trauma. An experimental study in pigs, using a new laser Doppler technique and radioactive microspheres. 
     - An evaluation of the surgeon's criteria for determining the viability of muscle during debridement. 
     - Microcirculatory and biochemical studies of skeletal muscle tissue after high energy missile trauma.

     - MUSCLE VIABILITY REVISITED: ARE WE REMOVING NORMAL MUSCLE? A CRITICAL EVALUATION OF DOGMATIC DEBRIDEMENT.




Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Tuesday, January 19, 2016 6:32 am