Emergency War Surgery NATO Handbook: Part III: General Considerations of Wound Management: Chapter XIX: Wounds and Injuries of Bones and Joints

Redebridement and Wound Closure

United States Department of Defense

After the wound has been debrided, irrigated, and appropriately dressed, it is not inspected for 4-10 days unless the clinical course dictates an earlier appraisal. Intervening dressing changes are not indicated unless the clinical course indicates that there is continued hemorrhage, vascular changes, or infection. This inspection of the wound should be performed in the operating room. At that time, if there is significant devitalized tissue or purulent drainage, redebridement is accomplished. If the wound is clean and without evidence of infection, a delayed primary closure is performed. The wound should not be closed with undue tension, nor with extensive development of flaps. Wounds that cannot be easily closed should be dressed for subsequent split-thickness skin grafting at the next echelon of surgical care. Any wound closed by the delayed primary technique should be followed carefully for evidence of inflammation or infection. If signs of infection develop, the wound should be reopened. If the patient is not to be retained at the forward hospital so that he can be followed for several days, it is advisable to defer delayed primary closure to those personnel in the evacuation chain who are able to provide proper continuing follow-up.

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Operational Medicine 2001

Health Care in Military Settings

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