Surgical wound debridement

General surgical tactics

Surgical wound debridement is viewed as working with the portal of entry for infection and requires immediate action. The basic algorithm includes the following steps:

• Removal of previously applied sutures.
• Wide separation of wound edges for adequate visualization.
• Thorough washing of tissues with hydrogen peroxide solution for mechanical cleansing and antisepsis.

Complicated and healed wounds

The surgeon's tactics vary depending on the condition of the wound and the presence of pathological substrates in it:

In the presence of necrosis or foreign bodies:

• Repeated surgical debridement is performed.
• All identified purulent streaks and formed abscesses must be opened.
• The surgery is completed with adequate drainage of the wound cavity.

If the wound has already healed but requires revision (e.g., foreign bodies remain):

• Excision of the formed scar is performed strictly within healthy tissues.
• Meticulous removal of all small foreign bodies is carried out.
• Important rule: after such a revision, the wound is not sutured.

Antibiotic Therapy

Concurrently with local surgical debridement, systemic medications are prescribed. The main goal is the prevention and treatment of severe purulent complications. Such complications include not only local suppuration of the wound itself, but also systemic respiratory tract lesions: purulent tracheobronchitis and pneumonia.

Broad-spectrum antibiotics are used to reliably cover the spectrum of possible pathogens.

Specific tetanus prophylaxis: routine

Tetanus toxoid adsorbed is used to prevent tetanus infection. Routine immunization covers risk groups: military personnel, machine operators, and construction workers.

Routine adult vaccination schedule:

1. Initially, 0.5 ml of toxoid is administered twice (with a 1-month interval between injections).
2. First booster: 0.5 ml of the drug after 1 year.
3. Subsequent boosters: administered every 5 years.

For immunization of children under 12 years of age, combined adsorbed diphtheria-tetanus-pertussis (DTP) vaccine is used.

Emergency tetanus prophylaxis

The algorithm for emergency protection in case of trauma and wounds directly depends on the patient's vaccination history.

• If the patient is vaccinated: a single administration of 0.5 ml of toxoid is sufficient.
• If the patient is not vaccinated (or status is unknown):
• 1 ml of toxoid is administered.
• As passive immunization, 3,000 IU of tetanus antitoxin OR 450–600 IU of tetanus immunoglobulin is added.
• To create robust long-term immunity, the schedule is continued: 0.5 ml of toxoid is administered after 1 month, and another 0.5 ml after 1 year.

Class and exam questions

What else to study on this topic

• Indications and technique for draining a purulent wound
• Methodology for opening abscesses and purulent streaks
• Characteristics and properties of tetanus antitoxin
• Features of DTP vaccine use in children
• Types of broad-spectrum antibiotics for surgical practice

Other topics in "CHAPTER 10. GENERAL ISSUES IN TRAUMATOLOGY"

Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.