WOUND DRESSINGS

Traumatic wounds should not be definitively closed until multiple adequate debridement and irrigation procedures have been performed. A series of surgical debridement and high-volume irrigation (9L/limb) is necessary to prepare wounds for closure or coverage. Wound closure and tissue coverage can take weeks. Serial wound stability without evidence of infection or continued myonecrosis is required. The wound should not be closed the first day it looks healthy. Serial intraoperative wound inspections are necessary. The risk of early wound closure is an infection that will require more debridement and possible loss of limb length. The extensive soft tissue destruction and degree of contamination in DCBI wounds make them infected until proven otherwise. Once there is no evidence of myonecrosis, tension can be placed on healthy skin and soft tissue to prevent loss of tissue domain and skin retraction. The preferred initial wound dressings are wet-to-dry gauze with Dakin’s (combat gauze can be used at initial operation as a hemostatic adjunct). After the risk of bleeding has subsided, negative pressure wound therapy can be used and is very useful for fixed wing evacuation.