The next step in wound preparation is debridement of nonviable tissue.12 Devitalized tissue may increase the risk of infection and delay healing by acting as a culture medium and inhibiting leukocyte phagocytosis. Debridement not only removes foreign matter, bacteria, and devitalized tissue, but also creates a sharp wound edge that is easier to repair. After debridement is completed, wounds should be reirrigated.

The most effective type of debridement is excision, because it converts a contaminated wound into a clean surgical wound. A standard surgical blade and scissors are used. Tissue that has a narrow base or lacks capillary refill will require excision. Heavily contaminated wounds require more extensive debridement, whereas adequate debridement of soft tissue, which includes specialized tissue such as tendons and nerves, may require consultation.

The goal of debridement is to reestablish a margin of normal tissue at wound edges. The easiest technique for excisional debridement is to mark an elliptical area around the sides of the wound and then, using a no. 15 surgical blade, cut only through epidermis. Skin lines should be respected, and extensive excision should be avoided.

Wounds with an extensive amount of nonviable tissue are more problematic. They may require a large amount of tissue removal (e.g., crush injuries) and will need more delayed wound closure or grafting. In general, a surgeon should be consulted to manage these wounds.

Debridement has become such a standard in wound care, it is difficult to conceive of a situation where this technique should not be applied. However, a recent study of low-velocity civilian gunshot wounds to the extremities found that conservative wound care had the same incidence of wound infection as routine wound debridement.9

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