debridement

It cleans and decontaminates fresh open contaminated wounds, removes blood clots and foreign bodies, removes tissues that have lost vitality, sutures wounds, minimizes pollution, and even becomes a clean wound, achieving first-stage healing, beneficial to the function of the injured part. Morphological recovery. Open wounds are generally classified into three categories: cleansing, pollution, and infection. Strictly speaking, there are very few clean wounds. Unexpected wounds are inevitably contaminated with different degrees. For example, the pollution is serious, the amount of bacteria is high and the virulence is strong. After 8 hours, it can become infected wounds. Local blood supply to the head and face wounds is good, and debridement can still be performed according to the contaminated wounds 12 hours after the injury. Debridement is a basic surgical procedure. The initial treatment of the wound is decisive for the healing of the wound and the restoration of the function and morphology of the injured part. It should be taken seriously. Treatment of diseases: hand traumatic head trauma Indication Various types of open injuries are considered fresh wounds with the following conditions: 1. Within 6-8 hours after injury. 2. The wound is less polluted and does not exceed 24 hours after injury. 3. Head and face wounds, generally within 24 to 48 hours after injury, and strive for suture after the debridement. 4. If the above conditions are not met, only debridement will not be sutured. Contraindications The age of the body is weak, the vital organs such as the heart and lungs are poor, and the surgery does not restore hope. Preoperative preparation 1. Before the debridement, the wounded must be fully carried out. If there is shock, rescue should be done first. After the shock is improved, strive for time to debride. 2. If the brain, chest, and abdomen have serious damage, they should be treated first. If there are open injuries in the extremities, attention should be paid to whether or not the fractures are combined at the same time. X-ray films are taken to assist in the diagnosis. 3. Apply analgesic and preoperative analgesic drugs. 4. If the wound is large and the pollution is serious, antibiotics should be used prophylactically. One hour before surgery, a certain amount of antibiotics should be used in the hands. 5. 1500U for tetanus antitoxin injection and 3000U for severe. Surgical procedure 1. Cleaning and decontamination: two steps to clean the skin and clean the wound. (1) Clean the skin: Cover the wound with sterile gauze, and then rub the oil around the wound with gasoline or ether. The operator washes his hands and gloves in the usual way, replaces the gauze covering the wound, washes the skin with a soft brush, sterilized soap water, and rinses with cold water. Then change to another brush and brush again, and dry the skin with sterile gauze. Brush twice for about 10 minutes. (2) Washing the wound: Remove the gauze covering the wound, rinse the wound with saline, and gently remove the dirt, blood clots and foreign bodies in the wound with a sterile tweezers or a small gauze ball. 2. Clean up the wound: perform anesthesia, dry the skin, disinfect the skin with iodine, alcohol, and cover the sterile surgical towel to prepare for surgery. The surgeon re-uses alcohol or new germination to soak hands, wear surgical gowns, and wear gloves to clean the wound. For shallow wounds, the incomplete skin around the wound can be removed 0.2-0.5cm, the cut surface can stop bleeding, eliminate blood clots and foreign bodies, remove the invasive tissue and the obvious contused wound edge tissue (including skin and subcutaneous tissue, etc.) Rinse with sterile saline. For deep wounds, the inferior fascia and muscles should be completely removed (the muscle cuts are not bleeding, or the scorpion is not contracted, indicating that it has been necrotic), but the viable muscle should not be removed to avoid excessive resection. . In order to deal with deeper wounds, it is sometimes possible to properly enlarge the wound and cut the fascia and clean the wound until it is relatively clean and reveals a tissue with better blood circulation. If there is a comminuted fracture at the same time, the fracture piece should be kept as much as possible; the small bone piece that has been separated from the periosteum should be removed. If the entrance and exit of the shallow penetrating injury are closer, the tissue bridge between the injured roads can be cut and the two wounds become one. If the injury is too deep, the deep part should not be cleaned from the entrance, but the injured road should be cleaned from the side cut. If the wound has active bleeding, it can be clamped with a hemostat before the debridement, or temporarily ligated to stop bleeding. Re-ligation when the wound is to be cleaned to remove the contaminated thread. The oozing blood can be stopped by warm saline gauze, or hemostasis can be stopped by a local hemostatic agent such as thrombin. 3. Repair the wound: Wash the wound again with saline after debridement. According to the specific conditions such as the degree of pollution, the size and depth of the wound, it is decided whether the wound is open or sutured, whether it is a stage or a delayed suture. A clean wound that has not been more than 12 hours can be sutured in one stage; a large and deep wound should be placed with a drainage strip during the first stage of suture; a wound that is heavily contaminated or cannot be thoroughly debrided at a particular site should be postponed, ie after debridement Place the Vaseline gauze strips in the wound before draining. After 4 to 7 days, if the wound tissue is rosy, no infection or edema, suture again. The head and face are rich in blood supply, and the healing power is strong. Although the injury time is long, as long as there is no obvious infection, the first stage suture should be won. When suturing the wound, there should be no dead space left, and the tension should not be too large. Important vascular injuries should be repaired or anastomosed, and the broken tendons and nerve trunks should be trimmed and sutured. The exposed nerves and tendons should be covered with skin. The open joint cavity damage should be thoroughly cleaned and sutured. The open injury of the thoracic and abdominal cavity should be thoroughly debrided, and the drainage tube or drainage strip should be placed. complication infection.

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