Tasks:
(1) gain a good exposure of the site to ensure a complete inspection
(2) achieve hemostasis with prevention of hematomas
(3) remove all foreign debris
(4) resect dead, necrotic and poorly vascularized tissue
(5) trim tissue in preparation for closure
(6) close the wound
Criteria for viable muscle tissue:
(1) consistency, with elasticity
(2) contractility when touched
(3) color that is red
(4) capacity to bleed when cut
Limbs which have been crushed for a prolonged period pose a special problem to debridement. Dead or seriously injured muscle after crush injury:
(1) is pale
(2) will bleed extensively even though the muscle is dead
(3) does not contract on physical or electrical stimuli
(4) loses elasticity
It is usually best not to debride these injuries unless necessary and then it may be necessary to perform extensive resections.
Sometimes with extensive injury or significant swelling the closure is done in 2 stages, with an initial debridement followed by a second look operation in 2-3 days.
