How to carry out initial treatment of traumatic wounds: debridement and wound bed preparation
Abstract
Traumatic wounds are commonly seen in veterinary practice, and can have a wide range of aetiology and severity. What all traumatic wounds have in common is that they present with the same impediments to healing: bacterial contamination; foreign material; and necrotic tissue. These impediments will be present in varying degrees depending on the aetiology and the time elapsed since injury, but in all cases they need to be addressed in the early stages of wound management. Wound lavage and debridement are commonly performed with the aim of producing a healthy wound bed. This article looks at how wounds are managed following lavage; utilising debridement techniques to remove necrotic tissue and foreign material from the wound, progressing the wound to a point where closure can be considered.
The first article in this series looked at initial wound assessment, preparation and wound lavage (Aldridge, 2013). The aim of wound lavage is to reduce bacterial contamination, and to help remove foreign material from the wound bed, both of which are common impediments to wound healing (Franz et al, 2008; Gregory, 2009). This article will discuss the next step in management of traumatic wounds: debridement.
Debridement is defined at the removal of damaged tissue or foreign objects from a wound (Figure 1). Necrotic tissue will delay wound healing and increase the risk of wound breakdown by acting as a nidus for infection. Necrotic tissue also slows wound healing by obstructing re-epithelialisation and wound contraction (Hart, 2002).
Traumatic wounds can be managed by primary closure, delayed primary closure or secondary closure; or they may be left to heal on their own by secondary intention (see Table 1 for wound closure options). The most important factors in deciding whether, and when, to close a wound are the degree of contamination (bacteria and foreign material), and necrotic tissue present (Bellah and Williams, 2009). A combination of lavage with debridement techniques enables the reduction of the level of contamination and the presence of necrotic tissue to a point where the closure technique chosen can be safely carried out. This may not be possible in a single procedure; wounds that have extensive contamination and ischaemia may require repeated debridement, and the use of more than one debridement technique, before closure can be considered. The mainstays of debridement of acute wounds in veterinary medicine are surgical and mechanical debridement.
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