THE PRINCIPLE of local wound treatment has been wound debridement. In undebrided wounds, devitalized muscle is a bed for bacterial growth with subsequent local infection which may progress to septicemia or clostridial myositis. For the untrained and/or inexperienced surgeon, such as would likely play a role in mass casualty situations, determination of the viability of muscle soon after wounding is difficult.
Only a surgeon who has had considerable experience in debriding wounds develops sufficient clinical judgment to accomplish a good debridement. The criteria used to determine dead muscle vary with the surgeon as they are based on individual experience. Primarily though, surgeons determine viability of the muscle at operation based on one or more of the following factors: contractability, consistency, color, and ability of the muscle to bleed.1 None of these criteria, either singly or in combination, is completely reliable. For the untrained or inexperienced physician, evaluation by use
Matsumoto T, Hardaway RM, Heisterkamp CA. Determination of the Viability of Muscle Soon After Wounding: Experimental Studies Using Local Dye for Delineation of Vital and Nonvital Muscle. Arch Surg. 1967;94(6):794–797. doi:10.1001/archsurg.1967.01330120048010
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