DEBRIDEMENT

Debridement is a medical procedure that involves the removal of dead, damaged, or infected tissue to enhance the healing potential of the remaining healthy tissue.

Why Debridement:

• Black, grey, or yellow dead (necrotic) tissue appears in the wound
• Yellow or white fibrous material (slough) made of dead cells builds up
• Signs of infection show up in the wound
• Foreign objects get trapped in the wound
• The wound shows no signs of healing for several weeks.

Wound types need debridement as a standard part of treatment:

• Stage 3 or 4 pressure ulcers (bedsores)
• Diabetic foot ulcers that don't respond to regular treatment
• Venous ulcers with major tissue damage
• Burns containing dead tissue
• Traumatic wounds with crushed or dead tissue
• Infected surgical wounds or those with dead tissue.

Debridement Methodes:

2. Chemical methods:

• Hydrogen peroxide kills germs on the wound. You may see foam or bubbles form on the wound surface. This method may irritate your skin near the wound edges and make your skin look red.
• Hypochlorite solution helps remove the dead tissue slowly.
• Iodine may help dry the dead tissues. Iodine may irritate and turn your skin yellow.

2. Mechanical methods:

• The wet to dry bandage method uses moist gauze placed in the wound and allowed to dry. The dead tissue comes out with the gauze when it is removed.
• The pulsed lavage method uses a medical device that cleans the wound with pulsating saline. The tissue waste is then removed with a suction tube.
• The whirlpool method uses warm, fast-moving water to soften and remove the dead tissue. This method cleans the wound and the tissue around it, and increases blood flow at the wound surface for healing.

After Debridement Care:

• Change dressings regularly: Daily, put on fresh dressings or follow the doctor's instructions to keep the wound clean and track how it heals.
• Keep dressings dry: Avoid swimming pools, baths, and hot tubs. Check with your doctor about when you can shower.
• Maintain proper wound hygiene: Wash your hands before and after touching your wound to avoid infection.
• Avoid pressure: Use special cushions to keep weight off your wound. If the wound is on your legs or feet, you might need crutches.
• Follow nutritional guidance: Eat enough calories and nutrients to help healing. A nutritionist can suggest good supplements.

The healing experience after wound debridement varies greatly between patients. For most people, healing takes 6 to 12 weeks. We observed that healing time depends on several key factors: the wound's severity, size, location, and the specific debridement method used.

Note: 

• Iodine: Elemental chemical, used in tinctures or compounds; strong antiseptic but can irritate skin and stain. Also essential for thyroid function.
• Betadine: Brand-name antiseptic containing povidone-iodine; safer for topical use, slower iodine release, less irritation, and effective against bacteria, viruses, and fungi. In essence, Betadine is a practical, stabilized form of iodine for wound care, while iodine itself is a broader chemical element with both antiseptic and nutritional roles.

Procedure:  

• Position the patient supine under spinal anesthesia 
• Skin antiseptic by betadine scrubbing 
• Lavage with normal saline and Hydrogen peroxide / betadine 
• Removed foreign body and infection tissue 
• Irrigate and debrid .... 
• Bone reduction and stabilization 
• Drilled ... 
• Washing with normal saline
• Skin closing and wet dressing with sterile compressive 

Post Operation Treatment:

1. PIV NSS 0.9% 1000mnl/24H
2. Ceftriaxone (1g): 1fl x 2 (IVL)
3. Gentamicine (80mg): 1A x 2 (IM)
4. Metronidazole (500mg): 1fl x 2 (PIV)
5. Paracetamol (1g): 1fl x 3 (PIV)
6. Tramadol (100mg): 1A x 2 (IM)
7. Cimetidine (200mg): 1A x 2 (IVL)