- Menu:
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Antibiotic Beads:
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Antibiotic Prophylaxis
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Antiseptics:
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Iodophors
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Carrier State
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Contaminated Wound Care
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Decubitus Ulceration
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Drains and Closure of Wounds
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Fracture Blisters
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Gun Shot Wounds:
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Pressure Irrigation
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Skin Preparation:
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Suture
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STSG
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Wound Dressings:
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Wound Bullet
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Wound Vac
- Debridement of Muscle: (
debridement of open tibia fractures);
- 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
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;
- Stages of Wound Repair:
- Injury damages circulation
- Inflammatory reaction
- Local hypoxia
- Anaerobic metabolism
- Lactate production
- Stimulation of fibroblast
- Vascular ingrowth
References
