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Debridement in osteoarticular infections: my principles and everyday practice
By Gérard Giordano in category UPDATE
Hôpital Joseph Ducuing, Toulouse, France / [email protected]
This article sums up my experience and thoughts gathered from 20 years of practice. It makes no claims to teach, just to share. For the benefit of our younger colleagues, I will attempt to explain this surgical step that is so fundamental to the successful management of infection, and how, as surgeons, they can apply a reproducible and efficient technique. I have happily restricted my report to debridement in periprosthetic hip and knee infection. There is one thing I need to clarify: in this article, ‘debridement’ should be understood in the English sense of the word¾excision.
A precise definition … and some questions
Surgical debridement may be defined as an ‘exhaustive and economical excision of all contaminated, infected, dead or dying tissue, together with the removal of all actual or potential foci of infection’. Taking this definition point by point, what does it imply?
- Exhaustiveness presupposes an ability to recognise an infected tissue on a macroscopic level, by comparison with the usual normal appearance of that tissue, whatever its type (skin, fascia, muscle, tendon, bone, cartilage). But has our education really trained us to do that or is it more a matter of personal experience? What I believe is that we are taught by our mentors, and so...
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