Mechanical debridement

Boulinguez S, Sparsa A, Bouyssou-Gauthier ML, Bedane C, Bonnetblanc JM. Adverse effects associated with EMLA cream used as topical anesthetic for the mechanical debridement of leg ulcers. J Am Acad Dermatol 2000 42(1 Pt l) 146-8. 

Debridement can be accomplished by surgical or mechanical means (wet-to-dry dressing changes). Other effective therapies are hydrotherapy, wound irrigation, and dextranomers. Pressure sores should be cleaned with normal saline. 

Phosphorus smokes are generated by a variety of munitions. Some of these munitions (such as the MA25 155-mm round) may, on explosion, distribute particles of incompletely oxidized white phosphorus. Contact with these particles can cause local burns, and systemic toxicity may occur if therapy is not administered. Therapy consists of topical use of a bicarbonate solution to neutralize phosphoric acids and mechanical removal and debridement of particles. A Wood s lamp in a darkened room may help to identify remaining luminescent particles. 

Stylet wires (Fig. 4.2) are used to stiffen leads for removal. Moreover, stylet wires can be used to debride foreign matter inside the lead body, confirm patency, and measure lead length. Stylet wires improve the effectiveness of lead removal when using either direct traction or mechanical sheaths. 

There are a variety of methods that can be used to debride a wound, including autolytic, chemical, mechanical, and surgical. Autolytic debridement utilises the body s own enzymes and moisture to dissolve and clean the wound of necrotic tissue. This method has the advantage of being virtually painless for the patient, but can take many weeks to achieve. A moist wound environment is the key factor to autolytic debridement, and is obtained by using occlusive or semi-occlusive wound dressings. 

A botulinum antitoxin is available and can be obtained from stores held in regional centres and the HPA Centre for Infections as well as Porton Down. The decision to use antitoxin therapy will usually be made by a senior infectious diseases clinician and should rely on clinical or historical features rather than laboratory test results. Surgical debridement and antibiotic therapy may be indicated for suspected wound botulism. Respiratory failure may require endotracheal intubation and mechanical ventilation with subsequent monitoring and treatment in a critical care environment. 

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