NEED FOR REPEATED DEBRIDEMENTS

The treatment team must appreciate the phenomenon of wound evolution and the high risk for invasive fungal infection and expectation that viability of the soft tissues will fluctuate over the course of several days. In the acute phase (<72 hours from injury) wounds should be frequently inspected in the operation room every 24 hours. In the later, sub-acute phase (3-7 days from injury) wounds may require less frequent treatment based on the presence of viable tissue and absence of ongoing necrosis or persistent contamination. Multiple debridements are routinely required and the severely injured, physiologically deranged patient should not undergo excessive surgical procedures during the initial operation other than those required to control hemorrhage and gross contamination.

Refer to JTS War Wounds: Wound Debridement and Irrigation and Invasive Fungal Infection in War Wounds CPGs for further guidance.22,18