SOFT TISSUE DEBRIDEMENT

An appropriate balance of adequate surgical debridement and restoration of physiology is critically important during the initial surgical procedure for DCBI patients. DCBI MOI results in wounds that are complex and extensive. They are grossly contaminated with dirt, fragment debris, clothing, and foliage. Wounds should be incised with well-planned incisions extending longitudinally from the primary zone of injury to healthy tissue with consideration of future reconstructive or closure options.22 Systematic irrigation and debridement of nonviable skin, subcutaneous tissue, fascia, muscle, periosteum, and bone is critical to reduce the bioburden and later risk of sepsis.22 Blast wounds tend to evolve and repeat surgical irrigation/debridement should be performed at least every 24 hours until the wound stabilizes and there is no further evidence of contamination, or ongoing myonecrosis. If tissue is questionable and not contaminated, it should be maintained and addressed at the subsequent surgical debridement the following day. However, since the timing of the next operation (often at the next role of care) is unpredictable, avoid leaving marginally viable tissue behind while in theater, as many of these complex wounds will develop progressive necrosis. When present, pelvic/perineal and pelvic wounds need to be similarly addressed.23

Refer to JTS War Wounds: Wound Debridement and Irrigation CPG for further guidance.19