War Wounds: Wound Debridement and Irrigation

Summary of Changes

- Inclusion of tetanus and antibiotic prophylaxis.
- Early identification and treatment of wounds at high risk for invasive fungal infection.
- Inclusion of antibiotic powder as an option for wound prophylaxis and contrasting effect of negative pressure wound therapy on local antibiotic delivery in wounds using polymethyl methacrylate (PMMA) antibiotic beads and antibiotic powder.
- Revision of section on a retained foreign object (RFO).

BACKGROUND

Wound debridement and irrigation (D&I) is the most frequently performed surgical procedure in the combat theater.1 Given the power of war munitions, prompt removal of nonviable tissue, debris, blood and bacteria is imperative to prevent local and systemic complications associated with such a wound.2 Appendix A outlines the injury patterns and resulting physiology from weapons of war. Care must be given to ensure all nonviable tissue is removed, while at the same time preserving as much soft tissue as possible for reconstructive surgery at higher echelons of care.3 Balancing these two competing factors often necessitates serial D&I. While there are a variety of different therapeutic options of varying efficacy, no one approach is perfect for all situations.

NOTE: Related CPGs: Invasive Fungal Infection in War Wounds, Acute Traumatic Wound Management in the Prolonged Field Care Setting, Infection Prevention in Combat-Related Injuries. CPGs can be viewed/downloaded from https://jts.health.mil/index.cfm/PI_CPGs/cpgs.