INITIAL OPERATIVE DEBRIDEMENT
Plan debridement during the command huddle. This is a priority for the first operative period and ideally done within the first hour, do not delay as these injuries are highly contaminated. Do not attempt primary closure of blast and penetrating wounds
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• Scrub with soapy aqueous chlorhexidine to remove surface contamination • Use a tourniquet if wound distribution permits • Clean skin using alcohol containing preparations • Extend wounds along fasciotomy lines in the tibia • Extensile incisions should consider and facilitate future amputation • Use logical “Clock Face” approach working around the wound from superficial to deep • “Create a tunnel not a funnel” by maintaining a broad front with the your wound debridement • Irrigate wounds with copious (5-9 litres) of low pressure normal saline, use potable water in austere or restricted resource circumstances) • Debride to viable tissue however if there is doubt leave the tissue and check again at 48 hours. Children have excellent blood supply and tissue preservation is vital for future definitive repair and rehabilitation
Remember: do not
• Do not separate children from their caregivers • Do not discuss procedures with other adults in front of little children
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